Tenormin Tablet (Atenolol) 25 MG, 50 MG, 100 MG Use Dosage Details
Tenormin Tablets 25 MG, 50 MG, 100 MG contains a very useful drug named Atenolol. It is a competitive B-1 selective adrenergic antagonist. On the other hand, Atenolol is similar to metoprolol, B-andrenergic antagonists which reduces the effects of sympathomimetic neurotransmitter like. Catecholamines by competing for receptor sites. It lowers the blood pressure in hypertension and slows the heart rate.
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Tab Tenormin Tablets Composition Ingredients Formula
- Each Film Coasted Tenormin Tablets containing 25 mg, 50 mg, or 100 mg of Atenolol Ph.Eur.
- Injection for intravenous use presented as an isotonie, citrate Buffered, aqucous,solution, containing 5 mg of Atenolol Ph.Eur in 10 ml.
Capsules & Tenormin Tablets Uses & Indications
- Angina arrhythmias
- Hypertension
- Angina
- Angina Pectoris
- Cardiac arrhythmia
- Myocardial Infarction
- Early and late Intervention
Tenormin Tablets Dosage Administration
The tenormin dose must be adjusted to individual requirements of the patients, with the lowest possible starting dosage. Meanwhile, the following are guidelines.
Dosage For Adults
Hypertension:
One tenormin tablet daily. Most patients respond to 100 mg daily given orally as a single dose. Some patients, however, will respond to 50 mg given as a further reduction in blood pressure may achieved by combining it with other antihypertensive agents. For example, Co-administration of the medication with a diuretic provides a highly effective and convenient antihypertensive therapy.
Angina:
Most patients with angina pectoris will respond to Tenormin 100 mg given orally once. Or 50 mg given twice daily. Therefore, It unlikely additional benefit will gained by increasing the dose.
Cardia Arrhythmia’s:
A suitable initial dose of Tenormin 2.5 mg (5ml) injected intravenously over a 2.5 minute period (i.e.1 mg / minute). Meanwhile, this may repeated at 5 minute intervals until a response observed, up to a maximum dosage of Tenormin 10 mg. On the other hand, If it given by infusion, 0.5 mg/kg body weight may administered over a 20 minute period if required, the injection or infusion may repeated every 12 hours.
Having controlled the arrhythmias with intravenous use of the medicine, a suitable oral maintenance dosage 50-100 mg daily, given as a single dose.
Myocardial Infarction:
Early intervention after acute myocardial infarction. Meanwhile, for patients suitable for treatment with intravenous beta-blockade and presenting within 12 hours of the onset of chest pain. However, Tenormin 5-10 mg should given by slow intravenous injection (1 mg / minute) followed by 50mg orally about 15 minutes later, provided no untoward effects occurred from the intravenous dose. This should followed by a further Tenormin 50 mg orally 12 hours after the intravenous and then 12 hours later by 100 mg orally, once daily. However, if bradycardia and hypertension requiring treatment, or any other untoward effects occur. It should discontinued.
Later intervention after acute myocardial infarction. On the other hand, for patients who present some days after suffering an acute myocardial infarction an oral dose of Tenormin (100 mg daily) is recommended for long-term prophylaxis of myocardial infarction.
Dosage For Elderly:
The general Dosage requirement may be reduced, especially in patients with impaired renal function.
Dosage For Children:
There is no paediatric experience with this and for this reason it is not recommended for use in children.
Renal Failure:
Since Tenormin is excreted via the kidneys the dosage should be reduced in cases of severe impairment of renal function. No significant accumulation of the medicine occurs in patient who have a creatinine clearance greater than 35 ml/min/1.73 m(normal range is 100 - 150 ml/min/1.73 m)
For patients with a creatinine clearance of 15-35 ml/min/1.73 m (equivalent to serum creatinine of 300-600 micromol/litre) the oral dose should be 50 mg daily and intravenous dose should be 10 mg once every two days. For patient with a creatinine clearance of < 15 ml/min1.73 m (equivalent to serum creatinine of >600 micromol/litre) the oral dose should be 25 mg daily or 50 mg on alternate days and the intravenous dose should be 10 mg once every four days.
Patient on haemodialysis should be given 50 mg orally after each dialysis: this should be done under hospital supervision as marked falls in blood pressure can occur.
Tab Tenormin Contraindications Details
Tenormin as with other beta-blockers, should not used in patients with any of the following known hypersensitivity to the active substance, or any of the excipients: Bradycardia ( <45bpm: cardiogenic shock:
- Hypotnsion: metabolic acidosis
- Severe peripheral arterial circulatory disturbances
- Second or third degree heart block
- Sick sinus syndromic
- Untreated phaeochromocytoma
- Uncontrolled heart
Tenormin (Atenolol) Special Warnings & Precautions
The medicine as with other beta-blockers Should not withdrawn abruptly. The dosage should be withdrawn gradually over a period of 7-14 days, to facilitate a reduction in beta-blocker dosage. Patients should be followed during withdrawal, especially those with ischaemic heart disease.
When a patient is scheduled for surgery, and decision is made to discontinue beta-blocker therapy, this should be done at least 24 hours prior to the procedure. The risk-benefit assessment of stopping beta-blockade should be made for each patient. If treatment is continued an anaesthetie with little negative inotropic activity should be selected to minimise the reactions by intravenous administration of atropine.
Although contra-indicated in uncontrolled heart failure ( see contra-indications), may be used in patients whose sings of heart failure have been controlled. Caution must be exercised in patients whose cardia reserve is poor.
May increase the number and duration of angina attack in patients with Prinzmetal’s angina due to unopposed alpha receptor mediated coronary artery vasoconstriction Tenormin is a beta-1 selective beta-blocker: consequently, its use may be considered although utmost caution must be exercised.
Since this medication is excreted via kidneys, dosage should be reduced in patient with a creatinine clearance of below 35ml/min/1.7m. Although cardiaoselective (betai) blockers, as with all beta-blockers, these are compelling clinical reasons for their use. Where such reasons exits, It may be used with caution. Occasionally, some increase in airways resistance may occur in asthmatic patients, however, and this may usually be reversed by commonly used dosage of bronchodilators such as salbutamol or isoprenaline.
As with other beta-blockers, in patients with a phaeochromocytoma, an alpha-blocker should be given concomitantly.
Tenormin (Atenolol) Drug Interactions
Combined use of beta-blockers and calcium channel blocker with negative inotropic effect e.g verapamil, diltiazem can lead to an exaggeration of these effects particularly in patient with impaired ventricular function and /or sino-atrial or atrio-ventricular, conduction abnormalitied. this may result in severe hypotension, bradycardia and cardiac failure. Neither the beta-blocker nor the calcium channel blocker should administered intravenously within 48 hours of discontinuing the other.
Concomitant therapy with dihydropyridined e.g nifedipine, may increase the risk of hypotension and cardiac failure may occur in patient with latent cardiac insufficiency.
Digitalis glycosides, in association with beta-blockers, may increase atrio-ventricular conduction time.
Beta-blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the tow drugs co-administered the beta-blocker should withdrawn several days after clonidine administration has stopped.
Class anti-arrhythmic drug (e.g disopyramide) and amiodarone may have a potentiating effect on atrial-conduction time and induce negative inotropic effect. Concomitant use of sympathomimetic agents, e.g adrenaline, may counteract the effect of beta-blockers.
Concomitant use with insulin and oral antidiabetic drugs may lead to intensification of the blood sugar lowering effects of these drugs. Symptoms of hypoglycemia, particularly tachycardia, may masked
Concomitant use of prostaglandin synthetase inhibiting drugs (e.g ibuprofen, indomethacin) may decrease the hypotensive effects of beta-blockers.
Caution must exercised when using anaesthetic agents with the medicine. The anaesthetist should informed and the choice of anaesthetic should an agent with as little negative inotropic activity as possible. Meanwhile, Use of beta-blockers with anaesthetic drugs may result in attenuation of the reflex tachycardia, and increase the risk of hypotension. Anaesthetic agents causing myocardial depression best avoided.
Pregnancy and Lactation:
It mainly crosses the placental barrier and appears in the cord blood. No studies have performed on the on the use of it in the first trimester and the possibility of foetal injury cannot excluded. Tenormin Tablets has used under close supervision for the treatment of hypertension in the third trimester. Administration of the tablets to pregnant woman in the management of mild to moderate hypertension has associated with intra-uterine growth retardation. The use of Tenormin in woman or may become, pregnant requires that the anticipated benefit weighted against the possible risks. Particularly in the first and second trimesters, since beta-blockers in general, have associated with a decrease in placental perfusion which may result in intra-uterine deaths, immature and premature delivers.
There is significant accumulation of this medicine in breast milk.
Neonates born to mother who are receiving the medicine at parturition or breast-feeding may be at risk for hypoglycaemia and bradycardia. However, Caution should exercised when it administered during pregnancy or to a woman who breast-feeding
Effect On Ability To Drive And Use Machines:
Use is unlikely to result in any impairment of the ability of patients to drive or operate machinery. However it should taken into account that occasionally dizziness or fatigue may occur.
Tenormin (Atenolol) Side Effects
- Tenormin medicine normally well tolerated. In clinical studies, the undesired events reported usually attributable to the pharmacological action of atenolol.
- Meanwhile, the following undesired events, listed by body system, have reported with the following frequencies:
Very common:
- (>10%)
Common:
- (1-9.9%)
Uncommon
- (0.1-0.9%)
Rare
- (0.01-0.09%)
Very Rare
- (<0.01%)
- Including isolated reports.
Cardiac Disorder
Common:
- Bradycardia
Rare:
- Heart failure deterioration
- Precipitation of heart block
Vascular Disorder
Common:
- Cold Extremities
Rare:
- Postural hypotension which may associated with syncope
- Intermittent cladication may increased if already present
- In susceptible patients Raynaud’s penomenon
Nervous System Disorders
Rare:
- Dizziness
- Headache
- Paraesthesia
Psychiatric Disorder
Uncommon:
- Sleep Disturbances of the type noted with other beta-blockers
Rare:
- Mood changes
- Nightmares
- Confusion
- Psychoses and hallucinations
Gastrointestinal Disorders
Common:
- Gastrointestinal disturbances
Rare:
- Mouth dry
Investigations
Uncommon:
- Elevations of transaminase levels
Very Rare:
- An increase in ANA ( Antinuclear Antibodies) has observed
- However the clinical relevance of this is not clear
Hepatobiliary Disorders
Rare:
- Hepatic toxicity including intra hepatic cholestasis
Blood & lymphatic System Disorders:
Rare:
- Purpura
- Thrombocytopenia
Skin & Subcutaneous Tissue Disorders
Rare:
- Alopecia
- Psoriasiform skin reaction
- Exacerbation of psoriasis
- Skin rashes
Eye Disorders
Rare:
- Dry eyes
- Visual disturbances
Reproductive System & Breast Disorders
Rare:
- Impotence
Respiratory, thoracic and mediastinal disorders
Rare:
- Bronchospasm may occur in patients
General Disorders & Administration Site Conditions
Common:
- Fatiue
- Discontintrance of the drug should considered if, according to clinical judgement. Meanwhile, The well-being of the patient adversely affected by any of the above reaction.
Overdose Symptoms & Treatment Guide
The symptoms of overdosage may include
- Bradycardia
- Hyprtension
- Acute cardiac insufficiency
- Bronchospasm
General treatment should include:
- Close supervision Treatment in an intensive care ward
- The use of gastric lavage
- Activated charcoal and a laxative to prevent absorption any drug still present in the gastrointestinal tract
- The use of plasma or plasma substitutes to treat hypotension and shock
- The use of haemodialysis or haemoperfusion may considered
Excessive bradycardia can countered with atropine 1-2 mg intravenously and / or a cardiac pacemaker. Therefore, If necessary, this may followed by a bolus dose of glucagon 10 mg intravenously. On the other hand, If required, this may repeated or followed by an intravenous infusion of glucagon 1-10 mg/hour depending on response. However, If no response to glucagon occur or if glucagon unavailable, a beta-adrenoceptor simulant such as dobutamine 2.5 to 10 micrograms/kg/minute by intravenous infusion may given. On the other hand, Dobutamine, because of its positive inotropic effect could also used to treat hypotension and inadequate to reverse the cardiac effects of beta-blocker if a large overdose has taken. The dose of dobutamine should therefore increased if necessary to achieve the required response according to the clinical condition of patients.
Tenormin (Atenolol) Tablets Storage Instructions
Most importantly, protect the medicine from direct sunlight and heat. On the other hand, always remember to keep your medical products out of the reach of the children. Meanwhile, store it on a cool and dry place below 30 C temperature.
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Tenormin (Atenolol) 25 MG, 50 MG, 100 MG Tablets Price (Rs. 131 PKR)