Atenolol

Assign inside before a meal, without chewing, with a small amount of liquid.

Arterial hypertension. Treatment begins with 50 mg of atenolol 1 time per day. To achieve a stable hypotensive effect requires 1-2 weeks of admission. With insufficient severity of the hypotensive effect, the dose is increased to 100 mg in a single dose. A further increase in the dose is not recommended, since it is not accompanied by an increase in the clinical effect.

In ischemic heart disease, tachysystolic heart rhythm disturbances - 50 mg 1 time per day.

Angina pectoris The initial dose is 50 mg per day. If during the week the optimal therapeutic effect is not achieved, increase the dose to 100 mg per day.

Correction of the dosage regimen is necessary for patients of advanced age and patients with impaired renal excretory function.

In the presence of renal failure, dose adjustment is recommended depending on creatinine clearance. In patients with renal insufficiency with creatinine clearance values ​​above 35 ml / min. / 1.73 m2 (normal values ​​are 100-150 ml / min. 1.73 m2), there is no significant accumulation of atenolol.

Atenolol penetrates the placental barrier and is found in umbilical cord blood. Research on the use of atenolol in the first trimester has not been conducted and, therefore, the possibility of a damaging effect on the fetus cannot be excluded.For the treatment of hypertension in the third trimester of pregnancy, the drug is used under close medical supervision. The use of atenolol during pregnancy may be a cause of impaired growth of the fetus.

Atenolol should be prescribed to pregnant women or women planning pregnancy, only in cases where the benefit to the mother outweighs the potential risk to the fetus, especially in the first and second trimester of pregnancy, since beta-adrenergic blockers reduce the level of placental perfusion, which can lead to fetal death or its immaturity and premature birth. In addition, side effects such as hypoglycemia and bradycardia can occur in both the fetus and the newborn.

Monitoring of patients taking atenolol should include monitoring of heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), blood glucose content in patients with diabetes mellitus (once every 4-5 months). In elderly patients, it is recommended to monitor renal function (1 time in 4-5 months).

The patient should be trained in the method of counting heart rate and instructed on the need for medical consultation with a heart rate of less than 50 bpm. In thyrotoxicosis, atenolol may mask certain clinical signs of thyrotoxicosis (for example, tachycardia). Sharp cancellation in patients with thyrotoxicosis is contraindicated, as it can strengthen the symptoms. In case of diabetes mellitus it may mask tachycardia caused by hypoglycemia. Unlike non-selective beta-adrenergic blockers, the insulin-induced hypoglycemia practically does not increase and does not delay the restoration of blood glucose to normal concentrations.

In patients with coronary heart disease (CHD), abrupt cancellation of beta-blockers may cause an increase in the frequency or severity of angina attacks, so stopping atenolol in patients with CHD should be carried out gradually.

Compared with non-selective beta-blockers, cardio-selective beta-blockers have less effect on lung function, however, with obstructive respiratory diseases, atenolol is prescribed only in case of absolute indications. If necessary, their purpose in some cases, we can recommend the use of beta2-adrenomimetics.

Cardioselective adrenergic blockers can be prescribed to patients with bronchospastic diseases in case of intolerance and / or ineffectiveness of other antihypertensive drugs, but the dosage should be strictly followed. Overdose is dangerous for the development of bronchospasm.

Special care is required in cases where surgery is required under anesthesia in patients taking atenolol. The drug should be stopped 48 hours before the intervention. As an anesthetic one should choose a drug with possibly minimally negative inotropic action.

With the simultaneous use of atenolol and clonidine, atenolol is stopped for a few days before clonidine in order to avoid the symptom of canceling the latter. Perhaps an increase in the severity of hypersensitivity reactions and the lack of effect from the usual doses of epinephrine on the background of aggravated allergic history.

Drugs that reduce catecholamine reserves (for example, reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect pronounced decrease in blood pressure or bradycardia.

In the case of elderly patients with increasing bradycardia (less than 50 units / min), arterial hypotension (systolic blood pressure below 100 mm Hg), atrioventricular blockade, bronchospasm, ventricular arrhythmias, severe impaired liver function and kidney, reduce the dose or stop treatment.

It is recommended to stop therapy in the development of depression caused by taking beta-blockers.

If intravenous verapamil is needed, this should be done at least 48 hours after taking atenolol.

With the use of atenolol, it is possible to reduce the production of tear fluid, which is important in patients using contact lenses.

You can not abruptly interrupt treatment because of the risk of severe arrhythmias and myocardial infarction. Cancellation is carried out gradually, reducing the dose for 2 weeks. and more (reduce the dose by 25% in 3-4 days).

It should be discontinued before the examination of the content in the blood and urine of catecholamines, normetanephrine and vanillyl almond acid; antinuclear titers. In smokers, the effectiveness of beta-blockers is lower. Pregnancy and lactation period.

Pregnant women should be appointed atenolol only in cases where the benefits to the mother outweigh the potential risk to the fetus. Atenolol is excreted in breast milk, so if during the period of breastfeeding the drug is indicated, it is better to stop breastfeeding for a while.

Influence on ability to drive motor transport and control mechanisms

During the period of treatment, it is necessary to refrain from engaging in potentially hazardous activities that require an increased concentration of attention and quickness of psychomotor reactions.

Symptoms: severe bradycardia, AV block II-III degree, increased symptoms of heart failure, excessive decrease in blood pressure, difficulty breathing, bronchospasm, dizziness, fainting, arrhythmia, ventricular extrasystole, cyanosis of the fingernails or palms of the fingernails or palms, convulsions.

Treatment: gastric lavage and prescription of absorbent drugs; in the event of bronchospasm, inhaled or intravenous beta2-adrenomimetika salbutamol is indicated. In violation of AV conduction, bradycardia - in / in the introduction of 1-2 mg of atropine, epinephrine or staging a temporary pacemaker; for ventricular premature beats, lidocaine (class 1A preparations are not used); with a decrease in blood pressure - the patient should be in the Trendelenburg position. If there are no signs of pulmonary edema - in / in plasma-substituting solutions, with inefficiency - the introduction of epinephrine, dopamine, dobutamine; in chronic heart failure - cardiac glycosides, diuretics, glucagon; with convulsions - in / in diazepam. Dialysis is possible.