Atenolol can be used as antihypertensive treatment for raised blood pressure, as anti-angina treatment to relieve symptoms and to improve tolerance and as an anti-arrhythmic to help regulate heartbeat and to treat myocardial infarctions. It is also used in the management of alcohol withdrawal, in anxiety states, migraine prophylaxis, hyperthyroidism, and tremor. Administration can be oral as tablets, capsules or a syrup, or by injection. It is also available as an antihypertensive treatment in the form of compound preparations with diuretics.
Atenolol can be used in conjunction with standard alcohol withdrawal treatments, and may may be useful in the treatment of some patients with alcohol withdrawal syndrome.
Normally used only in acute stress reactions, generalised anxiety disorder, and panic disorder. It is considered most effective in patients with somatic anxiety, and especially helps in the reduction of tremor and/or palpitations. The patient normally improves within 1-2 hours with relatively low doses.
The basis of angina therapy is to reduce the frequency and severity of the attack and to improve funtional capacity, and to prevent myocardial infarction or sudden death. At present there are three groups of anti-anginal drugs: nitrates, beta blockers, and calcium channel blockers. They can either be used alone or in combination with each other. Beta blockers are particularly effective in patients with excertational angina, normally young to middle aged people, and is especially helpful to thoose with hypertension, hyperdynamic left ventricular systolic function, or an excessive heart rate or large blood pressure increases due to excercise.
Atenolol is used to help combat cardiac arrhytmias primarily due to beta blockade, and is a class II anti-arrhytmic agent. It is also used to help control the ventricular response rate in chronic atrial fibrilation, supraventricular tachycardia and in symptomatic premature ventricular complexes.
Atenolol should not be given if congestive heart failure is not under control. It must be given with great care. A low initial dose is given, increasing gradually and continuing for several months.
The intravenous infusion of atenolol in the early period following myocardial infarction has been associated with a reduction in mortality. Analysis also suggests that beta blockers improve early survival by reducing the incidence of cardiac rupture. Studies demonstrate that in patients who survive acute myocardial infarction long-term treatment reduces mortality and rate of re-infarction. Patients are normally started on treatment whilst in hospital and continue taking medication for at least a year after the infarction.
Atenolol is effective in controlling sympathetic overactivity associated with hyperthyroidism including tremor, anxiety, and muscle weakness. Beta blockers in general have been used in the pre-operative management of hyperthyroidism.
Atenolol can be used for the prophylaxis of migraine but propanolol is more effective and is considered to be the treatment of choice. Long term treatment may be necessary but is controversial.
Beta blockers in general including atenolol have become drugs of first choice in patients with essential tremor, needing regular medication. Propanolol is by far the best predominantly due to blockade of beta2 receptors on extrafusal muscle fibres and muscle spindles, although there may be some CNS effect.
Atenolol causes a fall in blood pressure but is not without risks. The fall usually occurs 1-2 weeks after oral administration. Atenolol is not necassarily appropriate for all hypertensive patients.
