Black Box Warnings: As with all beta blockers the abrupt cessation of atenolol can lead to angina exacerbation, myocardial infarction, and ventricular arrhythmias. Gradual taper and cessation of atenolol is recommended in all patients in case of unrecognized coronary disease. If an exacerbation of angina or an acute myocardial syndrome develops the medication should be restarted.
Common Atenolol Side Effects: Many of the common atenolol side effects are related to its negative chronotropic effects. Bradycardia, orthostatic hypotension and hypotension even when not standing, dizziness and lightheadedness are common atenolol side effects. Cold extremities and leg pain are common, possibly related to decreased peripheral perfusion. Fatigue, depression, dyspnea and bronchospasm, lethargy and drowsiness are common generalized atenolol side effects. Gastrointestinal atenolol side effects include nausea and diarrhea.
Serious Atenolol Side Effects: Most of the serious atenolol side effects are exaggerations of the expected beta-blocker effects. These include heart block, congestive heart failure, cardiac arrhythmias and severe bradycardia. Bronchospasm, and Raynaud’s phenomenon can also be serious atenolol side effects. Lupus erythematosis and severe hypersensitivity reactions are also noted among the serious atenolol side effects.
Cautions and Drug Interactions: The use of atenolol is contraindicated in patients with cardiac conduction abnormalities including second or third degree heart block, sinus bradycardia, sick sinus syndrome if no pacemaker is present, WPW (Wolfe-Parkinson-White) syndrome, and in uncompensated congestive heart failure. Caution is also advised in thyroid disorders, diabetes mellitus if hypoglycemia is at all likely, in pregnancy or lactation, in patients with asthma or bronchospasm, and in peripheral vascular disease. As mentioned in the Black Box section, avoiding abrupt withdrawal is needed to avoid potentially lethal atenolol side effects. The list of drugs with potential interactions is extensive, and the reader should refer to the manufacturer’s prescriber guidelines or discuss their medications with their pharmacist for detailed information. Some of the more common interactions include cimetidine (Tagamet), non-steroidal anti-inflammatory drugs, amiodarone, other beta blockers, many antihistamine-decongestant combinations, digoxin, and Viagra.
Pregnancy and Lactation: Atenolol is pregnancy category D, with positive evidence of fetal risk documented. Atenolol is considered possibly unsafe in lactation.
Unusual Atenolol Side Effects: Raynaud’s phenomenon where cold exposure can lead to vasoconstriction in the hands or feet with associated color change and pain is a somewhat unusual atenolol side effect. Leg pain and lupus erythematosis are other atenolol side effect that would probably be considered unusual.
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