Beta blockers · Cardiovascular
Atenolol
Tenormin®(brand names vary by market)
The water-soluble beta blocker: fewer dreams, more dependence on the kidney.
Mechanism
Beta-1 selective antagonist. Hydrophilic, so it crosses into the brain far less than metoprolol, and it leaves by the kidney rather than the liver.
Open the interactive pathwayIndications
- Hypertension
- Angina
- Rate control
- Post myocardial infarction
Formulations
Dosing concepts
Renal impairment
Renally cleared, so the interval is extended or the dose reduced as clearance falls. It is the beta blocker most likely to accumulate quietly in an older patient whose kidneys have drifted.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~50%
- Half-life
- 6 to 7 h, much longer in renal impairment
- Elimination
- renal: Largely unchanged in the urine; no meaningful CYP involvement
- Protein binding
- Low, around 5%
Adverse effects
- Bradycardiacommon & serious
- Fatigue, cold hands and feetcommon
- Accumulation in renal impairmentseriousPresents as unexplained bradycardia and hypotension weeks after an unchanged dose.
Contraindications & precautions
Contraindications
- Severe bradycardia or high-grade AV block
- Decompensated heart failure
Precautions
- Renal impairment
- Asthma
- Diabetes
Interactions
Monitoring
Heart rate and blood pressure
Titration endpoints
Renal function
It is the exit route, and a falling eGFR raises the effective dose without anyone changing it
Counselling points
- Once daily.
- Do not stop suddenly.
- Tell us if you feel faint, very slow, or unusually tired.
Clinical pearls
- Its water solubility is why it produces fewer vivid dreams and less sleep disturbance than metoprolol, and that is a genuine reason to choose it for a patient who complains of exactly that.
- It has the weakest outcome evidence of the common beta blockers, particularly for stroke prevention in hypertension, which is why it has slipped down most guidelines even though it works.
References & review
- Atenolol product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.