Beta-Blockers Pregnancy: Caution should be exercised when atenolol is administered during pregnancy or to a woman who is breast-feeding. Atenolol crosses the placental barrier and appears in cord blood; no studies have been performed in the first trimester and the possibility of foetal injury cannot be excluded. Use in the management of mild to moderate hypertension has been associated with intra-uterine growth retardation, and the anticipated benefit must be weighed against the possible risks, particularly in the first and second trimesters. There is significant accumulation in breast milk — neonates born to mothers receiving atenolol at parturition or breast-feeding may be at risk of hypoglycaemia and bradycardia.

Atenolol

Brand names: Tenormin

Atenolol is a cardioselective beta-blocker used for angina, arrhythmias, hypertension and after myocardial infarction.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Hypertension: one tablet daily — most patients respond to 100 mg daily given orally as a single dose; some patients will respond to 50 mg given as a single daily dose. Angina: most patients respond to 100 mg given orally once daily, or 50 mg given twice daily

Route: Oral — SPC §4.2 method of administration: 'For administration by the oral route'

Frequency: Once daily (angina alternatively 50 mg twice daily)

Max: In angina, 'it is unlikely that additional benefit will be gained by increasing the dose' above 100 mg once daily or 50 mg twice daily

The dose must always be adjusted to the individual requirements of the patient, with the lowest possible starting dosage. Hypertension: 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, for example a diuretic. Oral maintenance after control of cardiac arrhythmias: 50 to 100 mg daily, given as a single dose. Elderly: dosage requirements may be reduced, especially in patients with impaired renal function; start with a lesser dose. WITHDRAWAL: should not be withdrawn abruptly — the dosage should be withdrawn gradually over a period of 7 to 14 days, with patients followed during withdrawal, especially those with ischaemic heart disease. If 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. PARENTERAL REGIMENS NOT REPRODUCED HERE: this SPC is for Atenolol 100 mg film-coated tablets and its §4.2 also outlines intravenous regimens for cardiac arrhythmias and for myocardial infarction, but it explicitly defers to a separate product, stating '(See also prescribing information for Atenolol Injection.)'. Those intravenous doses belong to a different product and have deliberately not been transcribed onto this oral monograph — clinician to source the Atenolol Injection SPC if an IV regimen is required for this page. PAEDIATRIC: 'There is no paediatric experience with Atenolol and for this reason it is not recommended for use in children.' SOURCE: UK SPC for Atenolol 100 mg film-coated tablets (eMC product 14163).

Dose adjustments

Renal

Atenolol is excreted via the kidneys, so the dosage should be adjusted in severe impairment of renal function. No significant accumulation occurs in patients with a creatinine clearance greater than 35 mL/min/1.73 m2. Creatinine clearance 15-35 mL/min/1.73 m2 (serum creatinine 300-600 micromol/L): the oral dose should be 50 mg daily. Creatinine clearance below 15 mL/min/1.73 m2 (serum creatinine above 600 micromol/L): the oral dose should be 25 mg daily or 50 mg on alternate days. Patients on haemodialysis should be given 50 mg orally after each dialysis, under hospital supervision as marked falls in blood pressure can occur. (The SPC also states intravenous dose reductions for these renal bands; those figures relate to Atenolol Injection and are not reproduced on this oral monograph.)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND 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. Atenolol may be used alone or concomitantly with other antihypertensive agents including thiazide-type diuretics, hydralazine, prazosin, and alpha-methyldopa. Angina Pectoris The initial dose of atenolol is 50 mg given as one tablet a day. If an optimal response is not …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-11-26. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Cardiogenic shock
Uncontrolled heart failure
Sick sinus syndrome
Second- or third-degree heart block
Untreated phaeochromocytoma
Metabolic acidosis
Bradycardia (below 45 bpm)
Hypotension
Severe peripheral arterial circulatory disturbances

Side effects

Bradycardia (common)
Cold extremities (common)
Gastrointestinal disturbances and fatigue (common)
Postural hypotension which may be associated with syncope, Raynaud's phenomenon, and increased intermittent claudication if already present (rare)
Sleep disturbances (uncommon); dizziness, headache and paraesthesia (rare); bronchospasm in patients with bronchial asthma or a history of asthmatic complaints (rare)
Elevations of transaminase levels (uncommon); hepatic toxicity including intrahepatic cholestasis (rare)

Interactions

Catecholamine-depleting drugs (e.g. reserpine) — additive effect; observe closely for hypotension and/or marked bradycardia
Calcium channel blockers — may have an additive effect when given with atenolol
Disopyramide — associated with severe bradycardia, asystole and heart failure when administered with beta-blockers
Amiodarone — negative chronotropic properties that may be additive to those seen with beta-blockers
Clonidine — beta-blockers may exacerbate the rebound hypertension that can follow clonidine withdrawal; the beta-blocker should be withdrawn several days before the gradual withdrawal of clonidine
Prostaglandin synthase inhibiting drugs (e.g. indometacin) — may decrease the hypotensive effects of beta-blockers
PROVENANCE: UK SPC §4.5 was not captured in the source bundle; these entries are taken from the US labelling in the same bundle and should be confirmed against the UK SPC

Clinical monograph

How it works

It selectively blocks β1-adrenoceptors, reducing heart rate, contractility and myocardial oxygen demand.

Prescribing in practice

It is renally cleared — reduce the dose in renal impairment.
Do not stop abruptly in ischaemic heart disease; use caution in asthma; it can mask hypoglycaemia.
It is no longer a preferred first-line antihypertensive, being reserved for specific indications.

Monitoring

Monitor heart rate and blood pressure and the response for the indication.

Counselling the patient

Do not stop it suddenly.
Tiredness, cold hands or a slow pulse can occur.
Report wheeze or marked dizziness.

Evidence & guidelines

Used for angina, arrhythmia and post-MI; not first-line for uncomplicated hypertension in current guidance (NICE NG136).

Reference: LIFE trial Lancet 2002; 359(9311):995-1003; ISIS-1 Lancet 1986; 2(8498):57-66; ESC Hypertension Guidelines 2018; MHRA SPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways