Atenolol is a selective beta-blocker, operates mainly in the beta1-adrenergic receptors of the heart ( “cardioselective beta-blocker”) without intrinsic sympathomimetic activity and no membrane stabilizing action.
Atenolol has antianginal, hypotensive and antiarrhythmic effects.
Atenolol reduces the automaticity of sinus node slows heart rate, slow atrioventricular conduction, reduces the excitability of myocardial contractility and cardiac output, reduces myocardial oxygen demand.
Indications for use:
atenolol-ratiopharm ® – coated oral primobolan, 25 mg is used to treat the following conditions:
– Functional disorders of the cardiovascular system (hyperkinetic cardiac syndrome, functional disorders of blood pressure regulation);
– chronic stable and unstable angina , especially in cases of combination with tachycardia and hypertension;
– supraventricular (supraventricular) arrhythmias;
– additional therapeutic activity when sinus tachycardia induced thyrotoxicosis; Paroxysmal supraventricular tachycardia
– fibrilloflutter (in cases of failure of treatment with high doses of cardiac glycosides); ventricular (ventricular) arrhythmias;
– ventricular arrhythmias caused by increased physical activity, intake of sympathomimetic agents, induction of anesthesia phase, including galotonovoy anesthesia;
– prevention of ventricular tachycardia and ventricular fibrillation;
Atenolol-ratiopharm ® – coated oral primobolan, 25 mg should not be used when:
– acute heart failure
– cardiogenic shock;
– atrioventricular block II and III level;
– syndrome sinus;
– sinoatrial blockade;
– sinus bradycardia;
– hypotension (systolic blood pressure less than 90 mmHg…)
– metabolic acidosis;
– late stages of peripheral circulatory disorders;
– simultaneous reception of MAO inhibitors (except MAO-B inhibitors);
– hypersensitivity to atenolol and other beta-blockers;
– increased sensitivity to other substances of the formulation.
in the treatment of drug atenolol-ratiopharm ® – coated oral primobolan, 25 mg is contraindicated intravenous administration of calcium channel blockers like verapamil and diltiazem or other antiarrhythmics (eg, disopyramide). The exceptions are patients who are in intensive care units.
With great caution and only under strict medical supervision should be prescribed atenolol-ratiopharm ® – coated oral primobolan, 25 mg under the following conditions:
– AV block of I degree;
– diabetes with strong vibrations blood sugar levels (possibility of severe hypoglycemic condition);
– abstaining from eating during religious fasting and heavy exercise (you may experience severe hypoglycemic states);
– reduced liver and / or kidney (in the appointment of atenolol in this category patients need constant monitoring of the dynamics of the functional state of the liver and / or kidney disease);
– symptomatic psoriasis or psoriasis in a personal or family history;
– patients with peripheral circulatory disorders, including Raynaud’s syndrome
– patients on desensitizing therapy or with severe allergic reactions history.
in all these cases, the treating physician should carefully weigh the benefit / risk ratio when administering the drug atenolol-ratiopharm ® coated oral primobolan, 25 mg.
In patients with a tendency to bronchospastic reactions (especially for obstructive airway diseases) is possible recurrence of bronchoconstriction.
In the case of patients in the treatment of other beta-blockers was observed the occurrence of thrombocytopenia or netrombotsitopenicheskoy purpura, it is necessary to bear in mind the possibility of the occurrence of this side effect and in the treatment of atenolol.
Use during pregnancy and lactation
Atenolol crosses the placental barrier and into breast milk.
During pregnancy (especially in the first 3 months) atenolol-ratiopharm ® – coated oral primobolan, 25 mg should be used only on strict conditions to Given careful weighing of benefit / risk ratio, because to date there is not enough experience of its use in pregnancy, especially in the early stages. If pregnant women have taken atenolol-ratiopharm ® – coated oral primobolan, 25 mg, in connection with the possibility of visiting the newborn bradycardia, hypoglycemia and respiratory depression treatment is stopped for 24-48 hours before the onset of labor. If this is not possible, the infant should be under particularly close supervision within 24-48 hours after delivery.
Atenolol penetrates into breast milk. The likelihood of the active substance in amounts which may represent a danger to the baby is very small, but the babies in such cases should be under special supervision.
Dosage and administration:
Atenolol-ratiopharm ® coated oral primobolan, 25 mg taken by mouth without chewing, drinking plenty of fluid (eg a glass of water) before a meal.
Doses of atenolol-ratiopharm medication ® – coated oral primobolan, 25 mg, and the duration treating physician are set individually depending on the therapeutic effect obtained. You can not change the dosage or discontinue atenolol without consulting your doctor.
A sudden withdrawal of the drug or treatment interruptions can cause cardiac ischemia with exacerbation of angina and hypertension, or even provoke a myocardial infarction. Therefore, removal of the drug and a decrease in dose should be made slowly, in tiers. Functional disorders of the cardiovascular system: Usually used 25 mg of atenolol a day (1 tablet atenolol-ratiopharm ® – coated oral primobolan, 25 mg).Chronic stable and unstable angina: typically prescribed atenolol 50-100 mg per day (2-4 oral primobolan atenolol-ratiopharm ® – coated oral primobolan, 25 mg), divided into 1-2 reception. hypertension: Treatment usually begins with a single application of 50 mg of atenolol (2 atenolol oral primobolan-ratiopharm ® – coated oral primobolan, 25 mg), divided into 1-2 reception. If necessary, the daily dose in a week increased to 100 mg (4 oral primobolan of atenolol-ratiopharm ® – coated oral primobolan, 25 mg), divided into 1-2 reception. Supraventricular (supraventricular) and ventricular (ventricular) arrhythmias: Atenolol is prescribed 1- 2 times a day, 50-100 mg (2-8 oral primobolan atenolol-ratiopharm ® – coated oral primobolan, 25 mg). The maximum daily dose is 200 mg of atenolol. The appointment of higher doses are used atenolol-ratiopharm ® – coated oral primobolan, 50 mg or atenolol-ratiopharm ® – coated oral primobolan, 100 mg.
Patients with severe renal dysfunction atenolol dose depend on the level of creatinine clearance: with creatinine clearance 10-30 ml / min dose reduced in 2 times, and at a creatinine clearance below 10 ml / min the dose is reduced by 4 times in comparison conventional.
Interaction with other substances:
In an application atenolol-ratiopharm ® – coated oral primobolan, 25 mg, and:
– insulin or oral hypoglycemic agents may intensify or prolong their effects. At the same time the symptoms of hypoglycaemia (especially tachycardia and tremor) may be blacked out or fade. It is therefore necessary to carry out regular monitoring of blood sugar;
– tricyclic antidepressants, barbiturates, phenothiazines, nitroglycerin, diuretics, vasodilators, and other antihypertensive agents (such as prazosin) can be enhanced hypotensive effect;
– blockers kaltsieyh channels (such as nifedipine), besides enhancing the hypotensive effect of may develop heart failure;
– calcium channel blockers (such as verapamil and diltiazem) or other antiarrhythmic drugs (eg disopyramide) may develop hypotension, bradycardia and other cardiac arrhythmias, heart failure;
– cardiac glycosides, reserpine, alpha-methyldopa, guansratsina and clonidine may be pronounced slowing of heart rate;
– norepinephrine and epinephrine may increase blood pressure;
– indomethacin may decrease the hypotensive effect of atenolol;
– narcotics and anesthetics enhanced hypotensive effect. This manifests addiditivnoe, the negative inotropic effect of both agents;
– peripheral muscle relaxants (eg, suxamethonium, tubocurarine) may be a strengthening of neuromuscular blockade. Therefore, before the operation, accompanied by anesthesia, the anesthetist should be informed that the patient takes atenolol:
– aminophylline and theophylline may cancel each other therapeutic effects;
– lidocaine may reduce its excretion and increased risk of toxicity of lidocaine.
Patients receiving both atenolol and clonidine, clonidine can be canceled only a few days after cessation of treatment with atenolol.
atenolol-ratiopharm ® – coated oral primobolan, 25 mg is usually well tolerated. Sometimes, however, especially at the beginning of treatment or at high doses, may experience complaints on the part of the central nervous system (dizziness, fatigue, headaches, blurred vision, sweating, sleep disturbances. Nightmares, depressive mood disorders, hallucinations).
Sometimes it can be transient complaints from the gastrointestinal tract (abdominal pain, nausea, retching, abdominal bloating, constipation, diarrhea). At lower doses and a more cautious escalating doses in the future, these phenomena often take place spontaneously.
Sometimes there are bradycardia, hypotension (orthostatic hypotension), violation of atrioventricular conduction and the emergence of symptoms of heart failure.
In some cases, patients with angina can not exclude the strengthening of seizures.
Occasionally there may be allergic skin reactions (itching, redness, rash, photosensitivity). Also occasionally be observed paresthesia (sensation of cold or itching of the extremities), rarely -. Muscle weakness or muscle spasms or increased complaints in patients with impaired peripheral circulation (including patients with Raynaud’s syndrome)
sometimes observed such violations on the part of the respiratory system such as dyspnea or apnea. . In predisposed patients may cause bronchial obstruction syndrome
Sometimes you can see dry mouth, conjunctivitis or reduced secretion of the lacrimal gland, which is especially revealed in patients using contact lenses.
In rare cases, possible haematological reactions: thrombocytopenic purpura, aplastic anemia, thrombosis. In very rare cases it can be a manifestation of latent diabetes mellitus or worsening of the current state of patients with diabetes mellitus.
It is sometimes possible emergence of lipid metabolism: the remaining within the normal total cholesterol level decreased HDL and increased triglycerides in plasma. In some cases, there is violation of libido and potency, gynecomastia.
In the treatment of atenolol requires regular medical supervision, as in connection with the individual characteristics of some patients may impair the ability to drive vehicles and serve the moving mechanisms. Generally, these effects are observed at the beginning of treatment, at higher dosages, and due to alcohol intake.
. Clinical presentation depends on the degree of intoxication and manifested primarily by disorders of the cardiovascular and central nervous systems
Overdosing can lead to hypotension, bradycardia (up to cardiac arrest), heart failure and cardiogenic shock. In severe cases there may be zatrudenie breathing, bronchospasm, vomiting, impaired consciousness; occasionally – generalized seizures. Treatment: In cases of overdose or menacing Singe the heart rate and / or blood pressure, treatment with atenolol interrupted. In the context of the intensive care unit in addition to measures aimed at the elimination from the body of atenolol. carry out careful monitoring of vital parameters and corrects them if necessary. If necessary, designate: – atropine (0.5 – 2.0 mg / in bolus) – Glucagon: initial dose of 1.10 mg / in (jet), subsequently – 2-2.5 mg / hr as continuous infusion, – sympathomimetic depending on body weight, and the resulting effect (dopamine, dobutamine, isoprenaline, oksiprenalin or adrenaline). when refractory to therapy bradycardia can temporarily transfer the patient to the pacing. when bronchospasm appoint beta2-sympathomimetic aerosol (when the effect of failure in / in) or aminophylline / in. in generalized seizures appoint slow in / diazepam.