From the Guidelines
If you're allergic to atenolol, metoprolol is typically the next beta blocker to try, given its similar mechanism of action and different chemical structure that may avoid triggering the same allergic reaction 1.
Key Considerations
- Metoprolol is available in immediate-release form (typically 25-100 mg twice daily) or extended-release form (25-200 mg once daily) 1.
- Other alternatives include bisoprolol (2.5-10 mg once daily) or carvedilol (3.125-25 mg twice daily), which also work by blocking beta-adrenergic receptors but have distinct chemical structures 2, 3.
- The choice of beta blocker should be based on the patient's condition, such as hypertension, heart failure, or angina, as well as other medical conditions and potential drug interactions 1, 2, 3.
Important Factors to Consider
- The patient's medical history, including any previous reactions to beta blockers or other medications 1, 2, 3.
- The presence of any underlying medical conditions, such as asthma, chronic obstructive pulmonary disease, or heart failure, which may affect the choice of beta blocker 1, 2, 3.
- The potential for drug interactions with other medications the patient is taking, including other cardiovascular medications or medications that may affect the metabolism of beta blockers 1, 2, 3.
Monitoring and Dosing
- When switching to a new beta blocker, the doctor will likely start at a lower dose and gradually increase it while monitoring for effectiveness and any adverse reactions 1, 2, 3.
- The target resting heart rate is 50 to 60 beats per minute unless a limiting side effect is reached 1, 2, 3.
- Maintenance doses are given in Table 15 of the guidelines, and the selection of the oral agent should include the clinician's familiarity with the agent 1, 2, 3.
From the Research
Alternatives to Atenolol
If a patient is allergic to atenolol, there are several other beta blockers that can be considered as alternatives. The choice of beta blocker depends on various factors, including the patient's medical condition, other medications they are taking, and their individual response to different beta blockers.
- Bisoprolol: Bisoprolol is a beta-1 selective blocker that has been shown to be effective in reducing mortality in patients with heart failure 4, 5. It is also used to treat hypertension and arrhythmias.
- Metoprolol: Metoprolol is another beta-1 selective blocker that is commonly used to treat hypertension, heart failure, and arrhythmias 4, 6. It has been shown to be more effective than atenolol in sustaining 24-hour blood pressure reductions 6.
- Carvedilol: Carvedilol is a non-selective beta blocker with alpha-1 blocking activity that is used to treat heart failure and hypertension 4, 7. It has been shown to be similar to bisoprolol in terms of mortality reduction in patients with heart failure 7.
Considerations for Switching Beta Blockers
When switching from atenolol to another beta blocker, it is essential to consider the patient's individual response to the new medication, as well as any potential interactions with other medications they are taking 8. The dosage and frequency of the new beta blocker may need to be adjusted to achieve optimal efficacy and minimize side effects.
- Dose equivalence: The dose of the new beta blocker should be equivalent to the dose of atenolol the patient was previously taking 8.
- Monitoring: The patient's blood pressure, heart rate, and other vital signs should be closely monitored after switching to a new beta blocker to ensure that the medication is effective and well-tolerated 8.