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Culture Documents
obstructive airways disease, unless there are com- sugar lowering effects of these drugs. Symptoms
pelling clinical reasons for their use. Where such of hypoglycaemia, particularly tachycardia, may be
reasons exist, Tenormin may be used with caution. masked (see Special warnings and precautions for
Occasionally, some increase in airways resistance use).
may occur in asthmatic patients, however, and this Concomitant use of prostaglandin synthetase inhib-
may usually be reversed by commonly used dosage iting drugs (e.g. ibuprofen, indomethacin), may
of bronchodilators such as salbutamol or isoprenaline. decrease the hypotensive effects of beta-blockers.
As with other beta-blockers, in patients with a phae- Caution must be exercised when using anaesthetic
ochromocytoma, an alpha-blocker should be given agents with Tenormin. The anaesthetist should be
concomitantly. informed and the choice of anaesthetic should be an
Interactions agent with as little negative inotropic activity as pos-
Combined use of beta-blockers and calcium chan- sible. Use of beta-blockers with anaesthetic drugs
nel blockers with negative inotropic effects e.g. may result in attenuation of the reflex tachycardia and
verapamil, diltiazem can lead to an exaggeration of increase the risk of hypotension. Anaesthetic agents
these effects particularly in patients with impaired causing myocardial depression are best avoided.
ventricular function and/or sino-atrial or atrio-ven- Pregnancy and lactation
tricular conduction abnormalities. This may result in Tenormin crosses the placental barrier and appears
severe hypotension, bradycardia and cardiac failure. in the cord blood. No studies have been performed
Neither the beta-blocker nor the calcium channel on the use of Tenormin in the first trimester and
blocker should be administered intravenously within the possibility of foetal injury cannot be excluded.
48 hours of discontinuing the other. Tenormin has been used under close supervision for
Concomitant therapy with dihydropyridines e.g. nife- the treatment of hypertension in the third trimester.
dipine, may increase the risk of hypotension, and Administration of Tenormin to pregnant women in
cardiac failure may occur in patients with latent car- the management of mild to moderate hypertension
diac insufficiency. has been associated with intra-uterine growth retar-
Digitalis glycosides, in association with beta-block- dation.
ers, may increase atrio-ventricular conduction time. The use of Tenormin in women who are, or may
Beta-blockers may exacerbate the rebound hyper- become, pregnant requires that the anticipated bene-
tension, which can follow the withdrawal of cloni- fit be weighed against the possible risks, particularly
dine. If the two drugs are co-administered, the beta- in the first and second trimesters, since beta-blockers,
blocker should be withdrawn several days before in general, have been associated with a decrease in
discontinuing clonidine. If replacing clonidine by placental perfusion which may result in intra-uterine
beta-blocker therapy, the introduction of beta-block- deaths, immature and premature deliveries.
ers should be delayed for several days after cloni- There is significant accumulation of Tenormin in
dine administration has stopped. (See also prescrib- breast milk.
ing information for clonidine). Neonates born to mothers who are receiving
Caution must be exercised when prescribing a beta- Tenormin at parturition or breast-feeding may be at
blocker with Class 1 antiarrhythmic agents such as risk for hypoglycemia and bradycardia.
disopyramide and quinidine. Caution should be exercised when Tenormin is
Concomitant use of sympathomimetic agents, administered during pregnancy or to a woman who
e.g. adrenaline, may counteract the effect of beta- is breast-feeding.
blockers. Effect on ability to drive and use machines
Concomitant use with insulin and oral antidiabetic Use is unlikely to result in any impairment of the
drugs may lead to the intensification of the blood ability of patients to drive or operate machinery.
ASTRAZENECA-TENORMIN 25mg, 50mg and 100mg Tablet - p.4/5
However it should be taken into account that occa- General treatment should include: close supervi-
sionally dizziness or fatigue may occur. sion, treatment in an intensive care ward, the use
Undesirable effects of gastric lavage, activated charcoal and a laxative
Tenormin is well tolerated. In clinical studies, the to prevent absorption of any drug still present in the
undesired events reported are usually attributable to gastrointestinal tract, the use of plasma or plasma
the pharmacological actions of atenolol. substitutes to treat hypotension and shock. The use
of haemodialysis or haemoperfusion may be consi-
The following undesired events, listed by body sys-
dered.
tem, have been reported.
Excessive bradycardia can be countered with atro-
-Cardiovascular: bradycardia; heart failure deterio-
pine 1-2mg intravenously and/or a cardiac pace-
ration; postural hypotension which may be associa-
maker. If necessary, this may be followed by a bolus
ted with syncope; cold extremities. In susceptible
dose of glucagon 10mg intravenously. If required,
patients: precipitation of heart block; intermittent
this may be repeated or followed by an intrave-
claudication; Raynauds phenomenon.
nous infusion of glucagon 1-10mg/hour depend-
-CNS: confusion; dizziness; headache; mood chan-
ing on response. If no response to glucagon occurs
ges; nightmares; psychoses and hallucinations;
or if glucagon is unavailable, a beta-adrenoceptor
sleep disturbances of the type noted with other
stimulant such as dobutamine 2.5 to 10 micro-
beta-blockers.
grams/kg/minute by intravenous infusion may be
-
Gastrointestinal: dry mouth, gastrointestinal dis-
given. Dobutamine, because of its positive inotro-
turbances, elevations of transaminase levels have
pic effect could also be used to treat hypotension
been seen infrequently, rare cases of hepatic tox-
and acute cardiac insufficiency. It is likely that these
icity including intrahepatic cholestasis have been
doses would be inadequate to reverse the cardiac
reported.
effects of beta-blocker blockade if a large overdose
-Haematological: purpura; thrombocytopenia.
has been taken. The dose of dobutamine should
-
Integumentary: alopecia; dry eyes; psoriasiform
therefore be increased if necessary to achieve the
skin reactions; exacerbation of psoriasis; skin rash-
required response according to the clinical condition
es.
of the patient.
-Neurological: paraesthesia.
-Reproductive: impotence Bronchospasm can usually be reversed by broncho-
-Respiratory: bronchospasm may occur in patients dilators.
with bronchial asthma or a history of asthmatic Pharmacodynamic properties
complaints. Betablocking agents, plain selective, CO7A B03
-Special senses: visual disturbances. Atenolol is a beta-blocker which is beta1-selective
-Others: hypersensitivity reactions, including angio-
(i.e. acts preferentially on beta1-adrenergic recep-
edema and urticaria; fatigue; an increase in ANA tors in the heart). Selectivity decreases with increas-
(Antinuclear Antibodies) has been observed, how- ing dose.
ever, the clinical relevance of this is not clear. Atenolol is without intrinsic sympathomimetic and
Discontinuance of the drug should be considered membrane stabilising activities and as with other
if, according to clinical judgement, the well-being of
beta-blockers, has negative inotropic effects (and
the patient is adversely affected by any of the aboveis therefore contraindicated in uncontrolled heart
reactions. failure).
Overdose As with other beta-blockers, the mode of action of
The symptoms of overdosage may include brady- atenolol in the treatment of hypertension is unclear.
cardia, hypotension, acute cardiac insufficiency and It is probably the action of atenolol in reducing car-
bronchospasm. diac rate and contractility which makes it effective
ASTRAZENECA-TENORMIN 25mg, 50mg and 100mg Tablet - p.5/5
in eliminating or reducing the symptoms of patients 90% of that absorbed reaches the systemic circula-
with angina. tion unaltered. The plasma half-life is about 6hours
It is unlikely that any additional ancillary properties but this may rise in severe renal impairment since
possessed by S (-) atenolol, in comparison with the the kidney is the major route of elimination. Atenolol
racemic mixture, will give rise to different therapeutic penetrates tissues poorly due to its low lipid solu-
effects. bility and its concentration in brain tissue is low.
Tenormin is effective and well-tolerated in most eth- Plasma protein binding is low (approximately 3%).
nic populations although the response may be less List of excipients
in black patients. -Tablets: Gelatin, Glycerol, Magnesium carbonate,
Tenormin is effective for at least 24 hours after a Magnesium stearate, Maize starch, Hypromellose,
single oral dose. The drug facilitates compliance Sodium lauryl sulphate, Titanium hydroxide.
by its acceptability to patients and simplicity of -100mg tablets only: Macrogol 300, Sunset yellow
dosing. The narrow dose range and early patient lake.
response ensure that the effect of the drug in indi- -
Injection: Citric acid, Sodium chloride, Sodium
vidual patients is quickly demonstrated. Tenormin is hydroxide, Water for injection
compatible with diuretics, other hypotensive agents Incompatibilities
and antianginal agents (see Interactions). Since it Compatibility with intravenous infusion fluids
acts preferentially on beta-receptors in the heart, Tenormin Injection is compatible with sodium chlo-
Tenormin may, with care, be used successfully in ride intravenous\infusion (0.9%w/v) and Glucose
the treatment of patients with respiratory disease, Intravenous Infusion BP (5% w/v).
who cannot tolerate non-selective beta-blockers. Shelf-life
Early intervention with Tenormin in acute myocar- Please refer to expiry date on the blister strip or
dial infarction reduces infarct size and decreases outer carton.
morbidity and mortality. Fewer patients with a threat- Special precautions for storage
ened infarction progress to frank infarction; the Tenormin Tablets: Do not store above 25C. Protect
incidence of ventricular arrhythmias is decreased from light and moisture.
and marked pain relief may result in reduced need Tenormin Injection: Do not store above 25C.
of opiate analgesics. Early mortality is decreased. Protect from light.
Tenormin is an additional treatment to standard cor-
onary care. Pack Size
Please refer to the outer carton for pack size.
Pharmacokinetic properties
Following intravenous administration, the blood lev- Date of revision of the text
els of atenolol decay tri-exponentially with an elimi- April 2004
nation half-life of about 6 hours. Throughout the
intravenous dose range of 5-10mg the blood level
profile obeys linear pharmacokinetics and beta-
adrenoceptor blockade is still measurable 24 hours
after a 10mg intravenous dose.
Absorption of atenolol following oral dosing is con-
sistent but incomplete (approximately 40-50%) with
peak plasma concentrations occurring 2-4 hours
after dosing. The atenolol blood levels are consis-
tent and subject to little variability. There is no signi-
ficant hepatic metabolism of atenolol and more than