Atenolol

Cardioselective beta1-blocker, does not have membrane stabilizing and internal sympathomimetic activity. It has hypotensive, antianginal and antiarrhythmic effects.

By blocking beta1-adrenergic receptors of the heart in low doses, it reduces the catecholamine-stimulated formation of cyclic adenosine monophosphate (cAMP) from adenosine triphosphate, reduces the intracellular current of calcium ions, has a negative chrono-, dromo-, bathmo- and inotropic effect (reduces heart rate (HR), inhibits conductivity and excitability, reduces myocardial contractility).

Total peripheral vascular resistance at the beginning of the use of beta-blockers (in the first 24 hours after oral administration) increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors and the elimination of stimulation of beta2-adrenergic receptors), which after 1-3 days returns to the initial level, and when long-term administration decreases.

The hypotensive effect is associated with a decrease in minute blood volume, a decrease in the activity of the renin-angiotensin-aldosterone system (more important for patients with initial hypersecretion of renin), the sensitivity of the baroreceptors of the aortic arch (there is no increase in their activity in response to a decrease in blood pressure (BP)) and influence on the central nervous system. The hypotensive effect is manifested by a decrease in both systolic and diastolic blood pressure, a decrease in stroke and minute blood volumes. In average therapeutic doses it has no effect on the tone of peripheral arteries. The hypotensive effect lasts 24 hours, and with regular use it stabilizes by the end of the second week of treatment.

The antianginal effect is mediated by a decrease in myocardial oxygen demand as a result of a decrease in heart rate (prolongation of diastole and improvement of myocardial perfusion) and contractility, as well as a decrease in the sensitivity of the myocardium to the effects of sympathetic innervation. Atenolol reduces heart rate at rest and during exercise. By increasing end-diastolic pressure in the left ventricle and increasing the stretch of ventricular muscle fibers, it can increase oxygen demand, especially in patients with chronic heart failure.

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and a slowdown of atrioventricular conduction. Inhibition of impulse conduction is observed predominantly in the antegrade direction and, to a lesser extent, in the retrograde direction through the atrioventricular node and along additional pathways.

Increases the survival rate of patients who have had myocardial infarction (reduces the incidence of ventricular arrhythmias and angina attacks).

Practically does not weaken the bronchodilating effect of isoprenaline. In contrast to non-selective beta-blockers, when prescribed in average therapeutic doses, it has a less pronounced effect on organs containing beta2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus), and on carbohydrate metabolism; the severity of the atherogenic effect does not differ from the effect of propranolol. To a lesser extent it has a negative bathmo-, chrono-, ino- and dromotropic effect.

When used in large doses (more than 100 mg/day), it has a blocking effect on both subtypes of beta-adrenergic receptors.

The negative chronotropic effect appears 1 hour after administration, reaches a maximum after 2-4 hours and lasts up to 24 hours.

Atenolol 100 mg

Atenolol

Registration number: РN 001152/01

Trade name of the drug: Atenolol

International nonproprietary name (INN): Atenolol

Dosage form: tablets

Composition: one tablet contains:

Active substance: atenolol 0.05 g (50 mg) or 0.01 g (100 mg)

Excipients: magnesium hydroxycarbonate (main magnesium carbonate), corn starch, food gelatin, magnesium stearate.

Description

Tablets from white to white with a creamy tint, flat-cylindrical in shape with a bevel on both sides (for a dosage of 50 mg) and with a bevel on both sides and a score on one side (for a dosage of 100 mg); Minor marbling is allowed.

Pharmacotherapeutic group: selective beta 1-adrenergic blocker.

ATH CODE: [С07АВ0З]

Pharmacological properties

Pharmacodynamics

It has antianginal, hypotensive and antiarrhythmic effects.

It does not have membrane stabilizing or internal sympathomimetic activity. Reduces the formation of cAMP from ATP stimulated by catecholamines.

In the first 24 hours after oral administration, against the background of a decrease in cardiac output, a reactive increase in total peripheral vascular resistance is observed, the severity of which gradually decreases within 1-3 days.

The hypotensive effect is associated with a decrease in cardiac output, a decrease in the activity of the renin-angiotensin system, baroreceptor sensitivity and an effect on the central nervous system. The hypotensive effect is manifested by both a decrease in systolic and diastolic blood pressure (BP), a decrease in stroke and cardiac output.

In average therapeutic doses it has no effect on the tone of peripheral arteries. The hypotensive effect lasts 24 hours, and with regular use it stabilizes by the end of 2 weeks of treatment.

The antianginal effect is determined by a decrease in myocardial oxygen demand as a result of a decrease in heart rate (prolongation of diastole and improvement of myocardial perfusion) and contractility, as well as a decrease in the sensitivity of the myocardium to the effects of sympathetic innervation. Reduces heart rate (HR) at rest and during physical activity. By increasing end-diastolic pressure in the left ventricle and increasing the stretch of ventricular muscle fibers, it can increase oxygen demand, especially in patients with chronic heart failure.

The antiarrhythmic effect is manifested by suppression of sinus tachycardia and is associated with the elimination of arrhythmogenic sympathetic influences on the conduction system of the heart, a decrease in the rate of propagation of excitation through the sinoatrial node and an extension of the refractory period. It inhibits the conduction of impulses in the antegrade and, to a lesser extent, in the retrograde directions through the AV (atrioventricular) node and along additional conduction pathways.

The negative chronotropic effect appears 1 hour after administration, reaches a maximum after 2-4 hours, and lasts up to 24 hours.

Reduces the automaticity of the sinus node, reduces heart rate, slows down atrioventricular (AV) conduction, reduces myocardial contractility, and reduces myocardial oxygen demand. Reduces myocardial excitability.

When used in average therapeutic doses, it has a less pronounced effect on the smooth muscles of the bronchi and peripheral arteries than non-selective beta-blockers.

Pharmacokinetics

Absorption from the gastrointestinal tract - fast, incomplete (50-60%), bioavailability -40-50%, time to reach maximum concentration in blood plasma - 2-4 hours. Poorly penetrates the blood-brain barrier, passes in small quantities through the placental barrier and into breast milk. Communication with blood plasma proteins - 6-16%. Practically not metabolized in the liver. The half-life is 6-9 hours (increases in elderly patients). Excreted by the kidneys by glomerular filtration (85-100% unchanged). Impaired renal function is accompanied by an extension of the half-life and cumulation: with creatinine clearance below 35 ml/min/1.73 m2, the half-life is 16-27 hours, with creatinine clearance below 15 ml/min/1.73 m2 - more than 27 hours (necessary dose reduction). It is excreted during hemodialysis.

Indications for use

- arterial hypertension;

- prevention of angina attacks (with the exception of Prinzmetal's angina);

— heart rhythm disturbances: sinus tachycardia, prevention of supraventricular tachyarrhythmias, ventricular extrasystole

Contraindications

Hypersensitivity to the drug, cardiogenic shock, atrioventricular (AV) block II-III stage, severe bradycardia (heart rate less than 45-50 beats/min.), sick sinus syndrome, sinoauricular block, acute or chronic heart failure (in the stage of decompensation ), cardiomegaly without signs of heart failure, Prinzmetal's angina, arterial hypotension (if used for myocardial infarction, systolic blood pressure less than 100 mm Hg), lactation period, simultaneous use of monoamine oxidase inhibitors (MAOIs), age up to 18 years (efficacy and security not installed).

With caution: diabetes mellitus, metabolic acidosis, hypoglycemia, history of allergic reactions, chronic obstructive pulmonary disease (including emphysema), first degree AV block, chronic heart failure (compensated), obliterating peripheral vascular disease (“intermittent” lameness, Raynaud's syndrome), pheochromocytoma, liver failure, chronic renal failure, myasthenia gravis, thyrotoxicosis, depression (including a history), psoriasis, pregnancy, old age.

Pregnancy and lactation period. Pregnant women should be prescribed atenolol only in cases where the benefit to the mother outweighs the potential risk to the fetus. Atenolol is excreted in breast milk, so during breastfeeding it should be taken only in exceptional cases and with great caution.

Directions for use and doses

Prescribed orally before meals, 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, 1-2 weeks of administration are required. If the hypotensive effect is insufficient, the dose is increased to 100 mg in one dose. Further increase in dose is not recommended, as it is not accompanied by an increase in clinical effect.

Angina pectoris. The initial dose is 50 mg per day. If the optimal therapeutic effect is not achieved within a week, increase the dose to 100 mg per day. Sometimes it is possible to increase the dose to 200 mg once a day. Elderly patients and patients with impaired renal excretory function require adjustment of the dosage regimen. In the presence of renal failure, dose adjustment is recommended depending on creatinine clearance. In patients with renal failure with creatinine clearance values above 35 ml/min/1.73 m2 (normal values are 100-150 ml/min/1.73 m2), significant accumulation of Atenolol does not occur.

For patients on hemodialysis, atenolol is prescribed 25 or 50 mg/day immediately after each dialysis, which must be done in a hospital setting, as a decrease in blood pressure may occur.

In elderly patients, the initial single dose is 25 mg (can be increased under the control of blood pressure and heart rate).

Increasing the daily dose above 100 mg is not recommended, since the therapeutic effect is not enhanced, and the likelihood of side effects increases.

Side effect

Cardiovascular system: development (worsening) of symptoms of chronic heart failure (swelling of the ankles, feet; shortness of breath), impaired atrioventricular conduction, arrhythmias, bradycardia, marked decrease in blood pressure, orthostatic hypotension, palpitations.

Central nervous system: dizziness, decreased ability to concentrate, decreased reaction speed, drowsiness or insomnia, depression, hallucinations, fatigue, headache, weakness, nightmares, anxiety, confusion or short-term memory loss, paresthesia in the extremities ( in patients with intermittent claudication and Raynaud's syndrome), muscle weakness, cramps.

Gastrointestinal tract: dry mouth, nausea, vomiting, diarrhea, abdominal pain, constipation, change in taste.

Respiratory system: dyspnea, bronchospasm, apnea, nasal congestion.

Hematological reactions: platelet purpura, anemia (aplastic), thrombosis.

Endocrine system: gynecomastia, decreased potency, decreased libido, hyperglycemia (in patients with non-insulin-dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), hypothyroid state.

Metabolic reactions: hyperlipidemia.

Skin reactions: urticaria, dermatitis, itching, photosensitivity, increased sweating, skin hyperemia, exacerbation of psoriasis, reversible alopecia.

Sense organs: blurred vision, decreased secretion of tear fluid, dry and sore eyes, conjunctivitis.

Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia. Laboratory indicators: agranulocytosis, leukopenia, increased activity of liver enzymes, hyperbilirubinemia.

Other: back pain, arthralgia, withdrawal syndrome (increased angina attacks, increased blood pressure).

The frequency of side effects increases with increasing dosage of the drug.

Overdose

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

Treatment: gastric lavage and administration of adsorbent drugs; if bronchospasm occurs, inhalation or intravenous administration of the beta 2-adrenergic agonist salbutamol is indicated. In case of impaired AV conduction, bradycardia - intravenous administration of 1-2 mg of atropine, epinephrine or placement of a temporary pacemaker; for ventricular extrasystole - lidocaine (class 1A drugs are not used); when blood pressure decreases, the patient should be in the Trendelenburg position. If there are no signs of pulmonary edema - intravenous plasma replacement solutions, if ineffective - administration of epinephrine, dopamine, dobutamine; for chronic heart failure - cardiac glycosides, diuretics, glucagon; for convulsions - intravenous diazepam. Dialysis is possible.

Interaction with other drugs

With the simultaneous use of atenolol with insulin, oral hypoglycemic drugs, their hypoglycemic effect is enhanced. When used together with antihypertensive drugs of different groups or nitrates, the hypotensive effect is enhanced. Concomitant use of atenolol and verapamil (or diltiazem) may cause a mutually enhanced cardiodepressive effect.

The hypotensive effect is weakened by estrogens (sodium retention) and non-steroidal anti-inflammatory drugs, glucocorticosteroids.

With the simultaneous use of atenolol and cardiac glycosides, the risk of developing bradycardia and atrioventricular conduction disorders increases.

When atenolol is prescribed simultaneously with reserpine, methyldopa, clonidine, verapamil, severe bradycardia may occur.

Simultaneous intravenous administration of verapamil and diltiazem can provoke cardiac arrest; nifedipine can lead to a significant decrease in blood pressure.

When taking atenolol simultaneously with ergotamine and xanthine derivatives, its effectiveness is reduced.

When discontinuing the combined use of atenolol and clonidine, treatment with clonidine is continued for several more days after discontinuation of atenolol.

Concomitant use with lidocaine may reduce its elimination and increase the risk of lidocaine toxicity.

Use together with phenothiazine derivatives helps to increase the concentration of each drug in the blood serum.

Phenytoin, when administered intravenously, and drugs for general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressive effect and the likelihood of a decrease in blood pressure.

When used together with aminophylline and theophylline, mutual suppression of therapeutic effects is possible.

Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect; the break in treatment between taking MAO inhibitors and atenolol should be at least 14 days.

Allergens used for immunotherapy or allergen extracts used for skin testing increase the risk of severe systemic allergic reactions or anaphylaxis.

Inhalation anesthetics (hydrocarbon derivatives) increase the risk of suppression of myocardial function and the development of arterial hypertension.

Amiodarone increases the risk of bradycardia and AV conduction depression.

Cimetidine increases plasma concentrations (inhibits metabolism). Iodine-containing radiopaque drugs for intravenous administration increase the risk of anaphylactic reactions.

Prolongs the effect of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins.

Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedatives and hypnotics increase depression of the central nervous system.

special instructions

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

The patient should be taught how to calculate heart rate and instructed about the need for medical consultation if the heart rate is less than 50 beats/min.

In thyrotoxicosis, atenolol may mask certain clinical signs of thyrotoxicosis (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it can increase symptoms. In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose to normal concentrations.

In patients with coronary heart disease (CHD), abrupt withdrawal of beta-blockers may cause an increase in the frequency or severity of anginal attacks, so discontinuation of atenolol in patients with CHD should be done gradually.

Compared with non-selective beta-blockers, cardioselective beta-blockers have less effect on pulmonary function, however, for obstructive airway diseases, atenolol is prescribed only when absolutely indicated. If it is necessary to prescribe them, in some cases the use of beta2-adrenergic agonists can be recommended.

Patients with bronchospastic diseases can be prescribed cardioselective adrenergic blockers in case of intolerance and/or ineffectiveness of other antihypertensive drugs, but the dosage should be strictly monitored. An overdose is dangerous due to the development of bronchospasm.

Particular attention is required in cases where surgical intervention under anesthesia is required in patients taking atenolol. The drug should be stopped 48 hours before the intervention. As an anesthetic, you should choose a drug with the least possible negative inotropic effect.

When using atenolol and clonidine simultaneously, atenolol should be discontinued several days before clonidine in order to avoid withdrawal symptoms from the latter.

It is possible that the severity of the hypersensitivity reaction may increase and there will be no effect from usual doses of epinephrine against the background of a burdened allergic history.

Medicines 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 a pronounced decrease in blood pressure or bradycardia.

In case of increasing bradycardia (less than 50 beats/min), arterial hypotension (systolic blood pressure below 100 mm Hg), atrioventricular block, bronchospasm, ventricular arrhythmias, severe dysfunction of the liver and kidneys, it is necessary to reduce dose or stop treatment.

It is recommended to discontinue therapy if depression caused by taking beta-blockers develops.

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

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

Treatment should not be abruptly interrupted due to the risk of developing severe arrhythmias and myocardial infarction. Cancellation is carried out gradually, reducing the dose over 2 weeks. or more (reduce the dose by 25% in 3-4 days).

Should be discontinued before testing the content of catecholamines, normetanephrine and vanillylmandelic acid in the blood and urine; antinuclear antibody titers.

Beta blockers are less effective in smokers.

Impact on the ability to drive and operate machinery. During the treatment period, it is necessary to refrain from engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Release form

Tablets of 50 and 100 mg.

10 or 20 tablets per blister pack. 30 or 50 tablets in polymer jars.

A jar of 3 or 5 blister packs of 10 tablets each or 2 blister packs of 20 tablets together with instructions for use are placed in a cardboard pack.

Conditions for dispensing from pharmacies

On prescription.

Storage conditions:

In a dry place, protected from light, at a temperature not exceeding 25°C.

Best before date:

3 years. Do not use after the expiration date.

Units:

pack

Drug interactions Atenolol

With the simultaneous use of atenolol with reserpine, methyldopa, clonidine, guanfacine and verapamil, severe arterial hypotension and bradycardia may develop. With simultaneous treatment with clonidine, it can be discontinued only a few days after stopping taking atenolol. Atenolol potentiates the hypoglycemic effect of oral antidiabetic agents and insulin. A few days before anesthesia with the use of drugs that have a cardiodepressive effect, it is necessary to stop taking atenolol; If it is impossible to discontinue atenolol, narcotic drugs with minimal negative inotropic effect should be used.

Overdose of the drug Atenolol, symptoms and treatment

An overdose of atenolol has been described in patients who took a single dose of about 5 g. Early manifestations of an overdose are drowsiness, respiratory failure, wheezing, and bradycardia. Congestive heart failure, arterial hypotension, bronchospasm and hypoglycemia may develop. Gastric lavage is performed, activated charcoal is prescribed orally, and glucagon is administered. Atenolol can be removed from the systemic circulation by hemodialysis. For bradycardia or AV block, atropine or isoproterenol is administered; if drug treatment is ineffective, transesophageal pacing is performed. For congestive heart failure, digitalization is performed and diuretics are prescribed.

List of pharmacies where you can buy Atenolol:

Moscow
Saint Petersburg

Special instructions for the use of the drug Atenolol

Persons with coronary artery disease who have taken atenolol should be warned about the danger of abrupt withdrawal. In patients with angina pectoris, upon abrupt withdrawal of beta-adrenergic receptor blockers, a withdrawal syndrome of varying severity is observed (from an increase in frequency and intensity of angina attacks to myocardial infarction and cardiac arrhythmias). The relative β1-selectivity of atenolol allows it to be used with caution in patients with bronchospastic diseases resistant to other antihypertensive drugs. Atenolol should be prescribed in minimally effective doses. Atenolol should be prescribed with caution to patients with diabetes mellitus, since β-adrenergic receptor blockers can mask the manifestations of hypoglycemia and potentiate the hypoglycemic effect of antidiabetic agents; β-adrenergic receptor blockers can mask the severity of some clinical manifestations of hyperthyroidism (for example, eliminate tachycardia). Abrupt withdrawal of β-adrenergic receptor blockers can provoke the development of a thyrotoxic crisis, therefore, if it is necessary to discontinue β-adrenergic receptor blockers in such patients, careful medical supervision is required. Atenolol penetrates the placental barrier and may have a pathological effect on the fetus. Prescribing atenolol starting from the second trimester of pregnancy can lead to the birth of premature babies. Atenolol is excreted in breast milk, so children may experience severe bradycardia. Caution should be exercised when prescribing atenolol during breastfeeding. Premature babies and children with kidney damage are more likely to develop side effects. The safety and effectiveness of atenolol in pediatric practice have not been established.

Atenolol Nycomed

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

The patient should be taught how to calculate heart rate and instructed about the need for medical consultation if the heart rate is less than 50/min.

In approximately 20% of patients with angina, beta blockers are ineffective. The main causes are severe coronary atherosclerosis with a low ischemic threshold (heart rate less than 100/min) and increased LV EDV, which impairs subendocardial blood flow. In smokers, the effectiveness of beta-blockers is lower.

Patients using contact lenses should take into account that during treatment the production of tear fluid may decrease.

In case of thyrotoxicosis, the drug may mask certain clinical signs of thyrotoxicosis (for example, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it can increase symptoms. In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose to normal concentrations.

When taking clonidine simultaneously, it can be discontinued only a few days after discontinuation of the drug Atenolol Nycomed.

It is possible that the severity of the allergic reaction may increase and there will be no effect from normal doses of epinephrine against the background of a burdened allergic history.

A few days before general anesthesia with chloroform or ether, you must stop taking Atenolol Nycomed. If the patient took the drug before surgery, he should select a drug for general anesthesia with minimal negative inotropic effect.

Reciprocal activation of the n.vagus can be eliminated by intravenous administration of atropine (1-2 mg).

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 a pronounced decrease in blood pressure or bradycardia.

The drug 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 monitored. An overdose is dangerous due to the development of bronchospasm.

If elderly patients develop increasing bradycardia (less than 50/min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV block, bronchospasm, ventricular arrhythmias, severe liver and kidney dysfunction, it is necessary to reduce the dose or stop treatment . It is recommended to discontinue therapy if depression caused by taking beta-blockers develops.

Use during pregnancy and lactation is possible if the benefit to the mother outweighs the risk of side effects in the fetus and child.

You should stop taking the drug Atenolol Nycomed before testing the content of catecholamines, normetanephrine and vanillylmandelic acid in the blood and urine; antinuclear antibody titers.

During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Side effects of the drug Atenolol

Most side effects are mild and temporary. Most likely are bradycardia, a feeling of coldness in the extremities, paresthesia, pain in the lower extremities, nausea, increased concentrations of liver enzymes and/or bilirubin in the blood serum, dizziness, headache, orthostatic hypotension, collapse, fatigue, weakness, drowsiness, general malaise, depression, hallucinations, psychosis, diarrhea, nausea, dyspnea, psoriasiform rash or exacerbation of psoriasis, purpura, reversible alopecia, thrombocytopenia and visual disturbances. Atenolol, like other β-adrenergic receptor blockers, can promote the formation of antinuclear antibodies and the development of lupus syndrome.

Use of the drug Atenolol

For hypertension (arterial hypertension) it is prescribed orally at an initial dose of 50 mg once a day. Used as monotherapy or in combination with other antihypertensive drugs. The maximum therapeutic effect usually develops after 1–2 weeks of treatment. If necessary, the dose can be increased to 100 mg 1 time per day; further increase in dose does not increase the effectiveness of treatment. For angina pectoris, a dose of 50–100 mg is prescribed once a day; in some cases, to achieve optimal effect it is necessary to use atenolol at a dose of 200 mg once a day. Atenolol should be withdrawn gradually. Elderly patients and those with kidney disease may require a reduction in the dose of atenolol. With a creatinine clearance of 15–35 ml/min, the half-life of atenolol is 16–27 hours, and the maximum daily dose is 50 mg; with creatinine clearance less than 15 ml/min, the half-life is more than 27 hours, and the maximum daily dose is 25 mg. Patients on hemodialysis should be prescribed 25 or 50 mg of atenolol after each procedure (only in a hospital due to the possibility of a sharp decrease in blood pressure).