Pronunciation:

(nay DOE lole)

U.S. Brand Names:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Pregnancy Implications:

Lactation:

Contraindications:

Warnings/Precautions:

Adverse Reactions:

>10%:

Central nervous system: Drowsiness, insomnia

Endocrine & metabolic: Decreased sexual ability

1% to 10%:

Cardiovascular: Bradycardia, palpitation, edema, CHF, reduced peripheral circulation

Central nervous system: Mental depression

Gastrointestinal: Diarrhea or constipation, nausea, vomiting, stomach discomfort

Respiratory: Bronchospasm

Miscellaneous: Cold extremities

<1% (Limited to important or life-threatening): Chest pain, arrhythmia, orthostatic hypotension, nervousness, headache, depression, hallucinations, confusion (especially in the elderly), thrombocytopenia, leukopenia, dyspnea

Overdosage/Toxicology:

Drug Interactions:

Albuterol (and other beta2 agonists): Effects may be blunted by nonspecific beta-blockers.

Alpha-blockers (prazosin, terazosin): Concurrent use of beta-blockers may increase risk of orthostasis.

Clonidine: Hypertensive crisis after or during withdrawal of either agent.

Drugs which slow AV conduction (digoxin): Effects may be additive with beta-blockers.

Epinephrine (including local anesthetics with epinephrine): Propranolol may cause hypertension.

Glucagon: Nadolol may blunt the hyperglycemic action of glucagon.

Insulin and oral hypoglycemics: Nadolol may mask symptoms of hypoglycemia.

Nadolol increases antipyrine's half-life.

NSAIDs (ibuprofen, indomethacin, naproxen, piroxicam) may reduce the antihypertensive effects of beta-blockers.

Salicylates may reduce the antihypertensive effects of beta-blockers.

Sulfonylureas: Beta-blockers may alter response to hypoglycemic agents.

Verapamil or diltiazem may have synergistic or additive pharmacological effects when taken concurrently with beta-blockers.

Ethanol/Nutrition/Herb Interactions:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Duration: 17-24 hours

Absorption: 30% to 40%

Distribution: Concentration in human breast milk is 4.6 times higher than serum

Protein binding: 28%

Half-life elimination: Adults: 10-24 hours; prolonged with renal impairment; End-stage renal disease: 45 hours

Time to peak, serum: 2-4 hours

Excretion: Urine (as unchanged drug)

Dosage:

Adults: Initial: 40 mg/day, increase dosage gradually by 40-80 mg increments at 3- to 7-day intervals until optimum clinical response is obtained with profound slowing of heart rate; doses up to 160-240 mg/day in angina and 240-320 mg/day in hypertension may be necessary.

Hypertension: Usual dosage range (JNC 7): 40-120 mg once daily

Elderly: Initial: 20 mg/day; increase doses by 20 mg increments at 3- to 7-day intervals; usual dosage range: 20-240 mg/day.

Dosing adjustment in renal impairment:

Clcr 31-40 mL/minute: Administer every 24-36 hours or administer 50% of normal dose.

Clcr 10-30 mL/minute: Administer every 24-48 hours or administer 50% of normal dose.

Clcr<10 mL/minute: Administer every 40-60 hours or administer 25% of normal dose.

Hemodialysis: Moderately dialyzable (20% to 50%); administer dose postdialysis or administer 40 mg supplemental dose.

Peritoneal dialysis: Supplemental dose is not necessary.

Dosing adjustment/comments in hepatic disease: Reduced dose probably necessary.

Dietary Considerations:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

Surgery: Atenolol has also been shown to improve cardiovascular outcomes when used in the perioperative period in patients with underlying cardiovascular disease who are undergoing noncardiac surgery. Bisoprolol in high-risk patients undergoing vascular surgery reduced the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction.

Withdrawal: Beta-blocker therapy should not be withdrawn abruptly, but gradually tapered to avoid acute tachycardia and hypertension.

Cardiovascular Considerations:

Hypertension: Beta-blocker therapy in the treatment of hypertension has been associated with improved cardiovascular outcomes. This class of drug is beneficial for elderly patients with hypertension. A recent UKPDS study showed that beta-blocker therapy (atenolol) was as effective as an ACE inhibitor in reducing cardiovascular events and that the benefits of therapy were related more to the degree of antihypertensive efficacy rather than the class of drug used.

Myocardial infarction: Beta-blockers, in general without intrinsic sympathomimetic activity (ISA), have been shown to decrease morbidity and mortality when initiated in the acute treatment of myocardial infarction and continued long-term. In this setting, therapy should be avoided in patients with hypotension, cardiogenic shock, or heart block.

Surgery: Atenolol has also been shown to improve cardiovascular outcomes when used in the perioperative period in patients with underlying cardiovascular disease who are undergoing noncardiac surgery. Bisoprolol in high-risk patients undergoing vascular surgery reduced the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction.

Atrial fibrillation: Beta-blocker therapy provides effective rate control in patients with atrial fibrillation.

Angina: Beta-blockers are effective in the treatment of angina as monotherapy or when combined with nitrates and/or calcium channel blockers. In patients with severe intractable angina requiring negative cardiac chronotropic medications, pacemaker placement has been carried out to maintain heart rate in the setting of large doses of beta-blockers and/or calcium channel blockers. Beta-blockers are ineffective in the treatment of pure vasospastic (Prinzmetal) angina.

Unstable angina/non-ST-segment elevation MI: In the treatment of unstable angina/non-ST-segment elevation MI, a beta-blocker, with the first dose administered intravenously if there is ongoing chest pain, followed by oral administration, is recommended (in the absence of contraindications).

Withdrawal: Beta-blocker therapy should not be withdrawn abruptly, but gradually tapered to avoid acute tachycardia and hypertension.

Heart failure: There is emerging evidence that beta-blocker therapy, without intrinsic sympathomimetic activity (ISA), should be initiated in select patients with stable congestive heart failure (NYHA Class II-III). To date, carvedilol, sustained release metoprolol, and bisoprolol have demonstrated a beneficial effect on morbidity and mortality. It is important that beta-blocker therapy be instituted initially at very low doses with gradual and very careful titration.

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

International Brand Names: