Selective beta-1 adrenergic blocker
ATC code: C07AB03 (Atenolol)
Selective beta-1 adrenergic receptor blocker in myocardium. Reduces heart rate, cardiac output, myocardial oxygen demand. Minimal effect on bronchial and vascular beta-2 receptors at usual doses. Hydrophilic, poor BBB penetration. T½ 6-7 h, renal elimination.
Second line
Hypertension. Per 2023 and SEH-LELHA 2022, atenolol is not first-line (LIFE 2002 trial showed inferiority to losartan in elderly cardiovascular outcomes). Used in CHD with tachycardia or beta-blocker intolerance. Dose 25-100 mg once daily.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Atenolol while breastfeeding – undesirable choice. RID 5.7-19.2% – the highest among beta-blockers. Cases of infant cyanosis, bradycardia, hypothermia, and hypoglycemia in breastfed infants have been reported (LactMed). Hale L3. Per 2020 and SEGO 2023, prefer labetalol, metoprolol, or propranolol. If atenolol was prescribed to a nursing mother, consider a second opinion.
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FDA category D. Associated with fetal growth restriction with long-term 1st-2nd trimester use. Avoid in pregnancy – prefer labetalol, methyldopa, nifedipine.
Not preferred during breastfeeding. RID 5.7-19.2%, infant cyanosis, bradycardia, hypoglycemia have been reported. Hale L3. Prefer labetalol, metoprolol, propranolol.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Atenolol is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier B), Hypertension during breastfeeding (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Atenolol (≥ 1 in 100): Fatigue, Bradycardia, Cold extremities, Decreased libido, Depressive episodes. See the Safety section for uncommon and serious reactions.
FDA category D. FDA category D. Associated with fetal growth restriction with long-term 1st-2nd trimester use. Avoid in pregnancy – prefer labetalol, methyldopa, nifedipine.
Not preferred during breastfeeding. RID 5.7-19.2%, infant cyanosis, bradycardia, hypoglycemia have been reported. Hale L3. Prefer labetalol, metoprolol, propranolol.
Atenolol is contraindicated in: Hypersensitivity; Bradycardia <50; 2nd-3rd AV block; Cardiogenic shock; Severe COPD/asthma. Full list in the Safety section.