Atenolol Dosing for Pediatric Patients
Atenolol is dosed at 0.5-2 mg/kg/day orally once daily in pediatric patients, with most children responding effectively to 0.5-1 mg/kg/day for conditions such as supraventricular tachycardia and hypertension. 1
Specific Dosing Recommendations
Standard Dosing Range
- Starting dose: 0.5 mg/kg/day orally once daily 1
- Effective dose range: 0.3-1.3 mg/kg/day 1
- Median effective dose: 0.7 mg/kg/day 1
- Maximum dose: Generally 2 mg/kg/day, not to exceed adult maximum doses 1
Administration Schedule
- Once-daily dosing is appropriate due to atenolol's prolonged half-life, particularly in patients with any degree of renal impairment 1, 2
- The long duration of action eliminates the need for divided doses, unlike propranolol which typically requires 2-3 times daily dosing 2
Key Clinical Considerations
Advantages Over Propranolol
- Cardioselective beta-blockade makes atenolol preferable in patients with asthma or diabetes mellitus compared to non-selective agents like propranolol 2
- Once-daily dosing improves compliance compared to propranolol's multiple daily doses 1, 2
- Lower CNS side effects due to limited brain penetration from low lipid solubility 2
Renal Considerations
- Dose reduction required when glomerular filtration rate is less than 30 mL/min 2
- Atenolol is eliminated virtually entirely unchanged in urine, making renal function assessment critical before dosing 2
- The prolonged half-life in renal impairment can be therapeutically advantageous but requires careful monitoring 3
Safety Profile
- In pediatric studies, 59% of children with supraventricular tachycardia were successfully controlled on atenolol monotherapy 1
- Adverse effects occurred in some patients, but none in the successful treatment group required discontinuation 1
- The drug is generally well-tolerated with a safety profile similar to other beta-blockers 2
Important Caveats
Dosing Errors to Avoid
- Do not simply scale adult doses by weight - this results in underdosing in children and overdosing in neonates due to differences in drug elimination and maturation 4
- Pediatric patients require individualized pharmacokinetic considerations based on age, size, and organ maturity 5
- Children aged 2 years and older are essentially mature and differ from adults only in size, while neonates and infants have immature elimination pathways 4
Contraindications and Precautions
- Avoid in patients with heart block, severe bradycardia, or decompensated heart failure 2
- Use with caution but preferred over non-selective beta-blockers in asthma or diabetes 2
- Monitor for hypoglycemia, particularly in susceptible patients, as beta-blockers can mask hypoglycemic symptoms 2