Atenolol

PUBLISHED DOSE = ORAL ONLY. The dose field above carries no parenteral figure. The intravenous regimens quoted further down these notes belong to a DIFFERENT ROUTE (Atenolol Injection) and are reproduced for reference only - do not act on them from this card. PRIOR VERIFY CARRY-FORWARD: the previous draft of this file was HELD because its source bundle had never been read, leaving those IV numbers untraceable and suspected of being filled from memory. The route-bleed risk the verify identified is real, so the demarcation above is kept. || WHY maxDose IS BLANK: neither source states an absolute oral ceiling with a 'maximum' cue for hypertension or angina. The UK SPC says only 'Most patients respond to 100 mg daily' (hypertension) and, for angina, 'It is unlikely that additional benefit will be gained by increasing the dose' above 100 mg once daily / 50 mg twice daily. The US label agrees for hypertension - 'Increasing the dosage beyond 100 mg a day is unlikely to produce any further benefit' - but for angina explicitly permits more: 'Some patients may require a dosage of 200 mg once a day for optimal effect.' The two 'maximum' figures that DO appear in the sources belong elsewhere and must not be used as this dose's ceiling: 'up to a maximum dosage of 10 mg' is the INTRAVENOUS arrhythmia limit, and the US 'maximum oral dosages' table (50 mg daily at CrCl 15-35; 25 mg daily below that) is a RENAL eligibility rule, reproduced under renalAdjustment. || VERBATIM (SPC 4.2) - HYPERTENSION: 'One tablet daily. Most patients respond to 100 mg daily given orally as a single dose. Some patients, however, will respond to 50 mg given as a single daily dose. The effect will be fully established after one to two weeks. A further reduction in blood pressure may be achieved by combining Atenolol with other antihypertensive agents.' ANGINA: 'Most patients with angina pectoris will respond to 100 mg given orally once daily or 50 mg given twice daily. It is unlikely that additional benefit will be gained by increasing the dose.' || CARDIAC ARRHYTHMIAS - INTRAVENOUS, verbatim: 'A suitable initial dose of Atenolol is 2.5 mg (5 ml) injected intravenously over a 2.5 minute period (i.e. 1 mg/minute). (See also prescribing information for Atenolol Injection.) This may be repeated at 5 minute intervals, until a response is observed up to a maximum dosage of 10 mg. If Atenolol is given by infusion, 0.15 mg/kg bodyweight may be administered over a 20 minute period. If required, the injection or infusion may be repeated every 12 hours. Having controlled the arrhythmias with intravenous Atenolol, a suitable oral maintenance dosage is 50-100 mg daily, given as a single dose.' || MYOCARDIAL INFARCTION, verbatim: 'For patients suitable for treatment with intravenous beta-blockade and presenting within 12 hours of the onset of chest pain, Atenolol 5-10 mg should be given by slow intravenous injection (1 mg/minute) followed by Atenolol 50 mg orally about 15 minutes later, provided no untoward effects have occurred from the intravenous dose. This should be followed by a further 50 mg orally 12 hours after the intravenous dose, and then 12 hours later by 100 mg orally, once daily. If bradycardia and/or hypotension requiring treatment, or any other untoward effects occur, Atenolol should be discontinued.' (The US label's MI regimen differs: 5 mg IV over 5 minutes, a second 5 mg IV 10 minutes later, then oral 50 mg 10 minutes after the last IV dose, 50 mg again 12 hours later, then 100 mg once daily or 50 mg twice a day for a further 6 to 9 days or until discharge.) || ELDERLY, verbatim: 'Dosage requirements may be reduced, especially in patients with impaired renal function.' 4.4: 'Should be used with caution in the elderly, starting with a lesser dose.' The US label adds a 25 mg starting option: 'Some renally-impaired or elderly patients being treated for hypertension may require a lower starting dose of atenolol: 25 mg given as one tablet a day. If this 25 mg dose is used, assessment of efficacy must be made carefully.' || NEVER STOP ABRUPTLY (4.4), verbatim: 'Should not be withdrawn abruptly. The dosage should be withdrawn gradually over a period of 7-14 days, to facilitate a reduction in beta-blocker dosage. Patients should be followed during withdrawal, especially those with ischaemic heart disease.' Before surgery: 'When a patient is scheduled for surgery, and a decision is made to discontinue beta-blocker therapy, this should be done at least 24 hours prior to the procedure.' || ASTHMA/COPD (4.4), verbatim: 'Although cardioselective (beta 1) beta-blockers may have less effect on lung function than non-selective beta-blockers, as with all beta-blockers, these should be avoided in patients with reversible obstructive airways disease, unless there are compelling clinical reasons for their use. Where such reasons exist, Atenolol may be used with caution.' || PAEDIATRIC (why paedDose is null), SPC 4.2 verbatim: 'There is no paediatric experience with Atenolol and for this reason it is not recommended for use in children.' US 8.4: 'Safety and effectiveness in pediatric patients have not been established.' No paediatric dose exists in this source and none has been invented; verify any under-18 use against a children's formulary. || STRENGTH NOTE: the fetched SPC is the 100 mg film-coated tablet, so 'One tablet daily' in that document means 100 mg; the 50 mg and 25 mg doses require other strengths.