From the Guidelines
The normal dose of atenolol for adults typically starts at 25-50 mg once daily, which can be increased to a maximum of 100 mg daily if needed for adequate blood pressure control or management of angina, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Key Considerations
- For elderly patients or those with kidney impairment, a lower starting dose of 25 mg daily is recommended with careful adjustment based on response.
- Atenolol is usually taken in the morning, with or without food, and should be taken consistently at the same time each day.
- It's essential not to stop taking atenolol suddenly as this can worsen underlying conditions; dosage should be gradually reduced over 1-2 weeks when discontinuing.
Mechanism and Efficacy
- Atenolol works by blocking beta-1 receptors in the heart, reducing heart rate and contractility, which lowers blood pressure and decreases the heart's oxygen demand.
- This makes it effective for treating hypertension, angina, and certain arrhythmias.
Monitoring and Follow-Up
- Patients should be aware that full therapeutic effects may take 1-2 weeks to develop, and regular monitoring of heart rate and blood pressure is recommended while taking this medication.
- The dosage may need to be adjusted based on the patient's response to the medication and the presence of any side effects.
Important Notes
- Beta blockers are not recommended as first-line agents unless the patient has ischemic heart disease (IHD) or heart failure (HF) 1.
- Atenolol is preferred in patients with bronchospastic airway disease requiring a beta blocker 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION Hypertension The initial dose of atenolol is 50 mg given as one tablet a day either alone or added to diuretic therapy. The full effect of this dose will usually be seen within one to two weeks. If an optimal response is not achieved, the dosage should be increased to atenolol 100 mg given as one tablet a day Increasing the dosage beyond 100 mg a day is unlikely to produce any further benefit. Angina Pectoris The initial dose of atenolol is 50 mg given as one tablet a day If an optimal response is not achieved within one week, the dosage should be increased to atenolol 100 mg given as one tablet a day. Some patients may require a dosage of 200 mg once a day for optimal effect.
The normal dose of atenolol is:
- 50 mg once daily for hypertension and angina pectoris
- 100 mg once daily if an optimal response is not achieved with the initial dose
- Up to 200 mg once daily for some patients with angina pectoris for optimal effect 2
From the Research
Normal Dose of Atenolol
The normal dose of atenolol can vary depending on the condition being treated.
- For mild to moderate hypertension, a dose of 100 mg daily is often considered optimal 3.
- In some cases, doses ranging from 50 mg to 200 mg daily may be used, depending on the patient's response to the medication 4, 3.
- Atenolol can be administered once daily, as its duration of activity is at least 24 hours 5.
- The choice of dose and administration schedule should be individualized based on the patient's specific needs and medical history.
Factors Influencing Dose
Several factors can influence the dose of atenolol used, including:
- The severity of the condition being treated (e.g. hypertension, angina pectoris) 5, 3
- The patient's age and medical history 6
- The presence of other medical conditions, such as heart failure or myocardial infarction 7, 6
- The use of other medications, which may interact with atenolol 5, 6
Comparison with Other Medications
Atenolol has been compared with other medications, including:
- Other beta-blockers, such as metoprolol and propranolol 7, 6
- Diuretics, calcium-channel blockers, and renin-angiotensin system inhibitors 6
- These comparisons have shown that atenolol can be effective in reducing blood pressure and cardiovascular disease, but its effects may be inferior to those of other medications in some cases 6