Atezen50 mg

Hypertension

Atezen is indicated for the treatment of hypertension, to lower blood pressure, and may be used alone or in combination with other antihypertensive agents. Current cardiology guidance (the 2017 ACC/AHA hypertension guideline) no longer lists beta-blockers such as Atezen as preferred first-line therapy for uncomplicated hypertension; ACE inhibitors, angiotensin receptor blockers, calcium-channel blockers, and thiazide diuretics are generally preferred first. Atezen remains guideline-supported when a patient has a compelling reason for beta-blockade (for example, a prior heart attack or certain arrhythmias) or when blood pressure is not controlled on first-line agents, and is often used as add-on/combination therapy rather than routine monotherapy.

Angina Pectoris

Atezen is indicated for the long-term management of angina pectoris (an established indication), reducing the frequency of angina episodes by lowering heart rate and myocardial oxygen demand.

Acute Myocardial Infarction

Atezen is indicated in hemodynamically stable patients with definite or suspected acute myocardial infarction, to reduce cardiovascular mortality; this is an established use but is initiated and supervised in a hospital setting.

Other Uses (Off-Label)

Atezen is sometimes used off-label by clinicians for heart-rate control in certain arrhythmias, such as atrial fibrillation, based on its beta-blocking action; this is not an FDA-approved indication and requires individualized specialist assessment.

After oral dosing, approximately 50% of an Atenolol dose is absorbed from the gastrointestinal tract, with peak plasma concentrations reached 2 to 4 hours after ingestion; food does not significantly affect absorption of Atenolol. Atenolol is only lightly bound to plasma proteins (about 6% to 16%), undergoes little or no hepatic metabolism, and is eliminated primarily unchanged by the kidneys, with over 85% of an intravenous dose recovered in urine within 24 hours. The elimination half-life of oral Atenolol is approximately 6 to 7 hours in people with normal kidney function, but this is prolonged in renal impairment (roughly 16-27 hours when creatinine clearance is 15-35 mL/min/1.73m², and over 27 hours when creatinine clearance is below 15 mL/min/1.73m²), which is why the dose of Atenolol must be reduced in patients with significant renal impairment (see Dosage and Use in Special Populations).

• Swallow the Atezen tablet whole with a glass of water; do not crush or chew unless advised by a doctor.
• Atezen may be taken with or without food, including with milk, as food does not significantly change absorption of Atezen; try to take Atezen at the same time each day.
• If taking Atezen twice daily, space doses about 10-12 hours apart (for example, morning and evening).
• If a dose of Atezen is missed, take it as soon as remembered unless it is almost time for the next dose, in which case skip the missed dose; do not double up on Atezen.
• Do not stop taking Atezen suddenly without medical advice, even if feeling well (see Precautions and Warnings).

• Clonidine: Atezen may worsen the rebound hypertension that can follow abrupt clonidine withdrawal; if both are being stopped, Atezen is generally withdrawn first, with clonidine tapered afterward, under medical supervision.
• Verapamil or Diltiazem (and other rate-limiting drugs): Combining these calcium-channel blockers with Atezen can cause bradycardia, heart block, or a drop in heart pumping function due to additive effects on cardiac conduction.
• Digitalis Glycosides (e.g., digoxin): Both digoxin and Atezen slow atrioventricular conduction and reduce heart rate, so using them together increases the risk of bradycardia or heart block.
• NSAIDs (e.g., ibuprofen, indomethacin): Prostaglandin-inhibiting pain relievers may blunt the blood-pressure-lowering effect of Atezen, so blood pressure should be monitored if an NSAID is added to Atezen.
• Insulin and Oral Antidiabetic Medicines: Atezen can mask warning signs of low blood sugar such as a fast heart rate, increasing the risk of unrecognized or prolonged hypoglycemia in people with diabetes (see Use in Special Populations).
• Other Beta-Blockers: Combining Atezen with another beta-blocker is not recommended, as it increases the risk of excessive slowing of the heart rate and low blood pressure.
• Anesthetic Agents (during major surgery): Atezen can blunt the heart's normal reflex response to the stress of anesthesia and surgery; the anesthesia team should be informed that a patient is taking Atezen.

Common Side Effects

Bradycardia (slow heart rate), cold hands or feet, fatigue or tiredness, dizziness or lightheadedness, low blood pressure, and gastrointestinal symptoms such as nausea or diarrhea have been reported with Atezen. Some patients report low mood or vivid dreams while taking Atezen.

Serious Side Effects – Seek Medical Attention

Seek prompt medical attention if any of the following occur while taking Atezen: very slow or irregular heartbeat, fainting, severe dizziness, signs of worsening heart failure (increasing shortness of breath, swelling of the ankles/legs, sudden weight gain), wheezing or difficulty breathing (especially in people with asthma or COPD), or signs of an allergic reaction (rash, swelling of the face/throat, severe itching). Do not stop Atezen abruptly to manage side effects — contact a doctor first (see Precautions and Warnings).

Pregnancy

Atezen can cause fetal harm. Use of Atezen starting in the second trimester of pregnancy has been associated with infants born small for gestational age (fetal growth restriction); recent meta-analyses continue to examine this association. Atezen should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus, and only under close specialist (obstetric) supervision; a legacy A/B/C/D/X pregnancy letter category is not assigned here because current guidance favors individualized risk-benefit counseling over a single letter grade.

Breastfeeding

Atezen passes into breast milk in relatively high amounts compared with plasma (reported milk-to-plasma ratios roughly 1.5 to 6.8), and clinically significant bradycardia has been reported in breastfed infants, including case reports of infant cyanosis, low body temperature, and slow heart rate that resolved after breastfeeding was stopped. Because of this, other beta-blockers with less milk transfer are generally preferred while nursing a newborn, a preterm infant, or when the mother is on a high dose of Atezen. If Atezen is used during breastfeeding, the infant should be monitored for lethargy, poor feeding, or a slow heart rate, and a doctor should be consulted promptly if these occur.

• Do not stop Atezen abruptly: Stopping Atezen suddenly, particularly in patients with underlying heart disease, has been associated with worsening angina, heart attack, and dangerous heart rhythm disturbances; when discontinuation of Atezen is needed, the dose should be reduced gradually over one to two weeks under medical supervision.
• Bronchospastic disease (asthma/COPD): Patients with bronchospastic disease should, in general, not receive beta-blockers such as Atezen; if Atezen is used at all in these patients, Atezen should be given at the lowest effective dose with caution and a beta-2 agonist available.
• Masking of hypoglycemia symptoms: Atezen may blunt the early warning signs of low blood sugar (such as a racing heart) in people with diabetes, increasing the risk of severe or prolonged hypoglycemia going unnoticed; blood sugar should be monitored closely in patients taking Atezen.
• Thyrotoxicosis: Atezen can mask signs of an overactive thyroid (such as a fast heart rate); abrupt withdrawal of Atezen in a patient with thyrotoxicosis may precipitate thyroid storm, so dose tapering and close monitoring are needed.
• Heart failure and conduction disorders: Atezen should be used with caution in patients with a history of heart failure or conduction abnormalities, as beta-blockade from Atezen can further reduce heart function in susceptible individuals.
• Peripheral vascular disease: Atezen may worsen symptoms of peripheral arterial circulatory disorders, such as Raynaud's phenomenon.
• Major surgery/anesthesia: Atezen blunts the heart's reflex response to the stress of surgery and anesthesia; the anesthesia and surgical team should be told that the patient is taking Atezen.
• Renal impairment: Because Atezen is eliminated mainly by the kidneys, patients with reduced kidney function need a lower dose of Atezen and regular monitoring (see Dosage and Use in Special Populations).

The most common effects of Atezen overdose are an excessively slow heart rate (bradycardia) and low blood pressure (hypotension). Other reported effects include lethargy, wheezing or bronchospasm, and, in severe cases, breathing difficulty or signs of heart failure; survival has been reported even after acute Atezen doses as high as 5 g. If an overdose of Atezen is suspected, do not induce vomiting unless specifically directed to do so by a doctor or poison control service, and seek emergency medical attention or contact a poison control service immediately. Hospital treatment may include close monitoring, gastric decontamination if appropriate and timely, and supportive measures such as atropine for a very slow heart rate, medicines or a temporary pacemaker for heart block, intravenous fluids or medicines to support blood pressure, and treatment for bronchospasm; Atezen can be removed from the blood by hemodialysis in severe cases.

Store Atezen tablets according to the storage instructions on the product label, generally at room temperature, away from direct sunlight, heat, and moisture, and out of reach of children. Do not use Atezen beyond its expiry date.

Children

Safety and effectiveness of Atezen have not been formally established in pediatric patients; see Pediatric Uses for details.

Elderly

Dose selection for elderly patients taking Atezen should be cautious, usually starting at the lower end of the dosing range, reflecting the greater likelihood of decreased kidney function and of other diseases or other medicines in this age group.

Renal Impairment

Because Atezen is eliminated mainly by the kidneys, significant drug accumulation occurs as kidney function declines; dose reduction of Atezen is required as outlined in the Dosage table, and renal function should be monitored regularly.

Hepatic Impairment

Atezen undergoes little or no liver metabolism, so a specific dose adjustment of Atezen for liver impairment is not established; however, caution and clinical monitoring are still advised, and dosing should be individualized by a healthcare professional.

Diabetes

People with diabetes taking Atezen should monitor blood sugar closely, since Atezen can mask early warning signs of hypoglycemia such as a fast heart rate (see Precautions and Warnings and Interaction).

For hypertension, Atezen is typically used as a long-term, often lifelong, treatment to keep blood pressure controlled, with periodic review by a doctor. For angina, Atezen is generally continued long-term to keep symptoms controlled. Following an acute myocardial infarction, Atezen is usually continued for an extended period as directed by the treating physician, based on the patient's cardiac status. In all cases, the exact duration of Atezen treatment should be determined and periodically reassessed by a healthcare professional, and Atezen should never be stopped abruptly (see Precautions and Warnings).

Atenolol selectively blocks beta-1 adrenergic receptors, which are found mainly in heart muscle, reducing heart rate, the force of heart contraction, and cardiac output, and suppressing renin release from the kidneys; these combined effects of Atenolol lower blood pressure and reduce the heart's oxygen demand, which helps prevent angina. Atenolol's beta-1 selectivity is relative rather than absolute and diminishes at higher doses, at which point effects on beta-2 receptors (for example, in the airways) become more likely.

Safety and effectiveness of Atezen in pediatric patients have not been formally established by regulatory review, and pediatric hypertension is not an approved indication for Atezen. Despite this, some pediatric specialists use Atezen off-label for childhood hypertension, with reported doses in the range of about 0.5 to 1 mg/kg once daily, up to a maximum of about 2 mg/kg per day (not exceeding 100 mg/day), individualized and supervised by a pediatric specialist. Atezen should only be given to a child under the direct supervision of a pediatrician or pediatric cardiologist, with attention to kidney function, heart rate, and blood pressure monitoring.