Atenolol

Naomi Carr
Author: Naomi Carr Medical Reviewer: Morgan Blair Last updated:

Atenolol, also known as Tenormin, is a beta-blocker typically used for the treatment of various heart conditions. At times, this medication is also prescribed to treat symptoms of anxiety disorders. Always take this medication exactly as prescribed and discuss with your doctor before taking any other medications (prescribed or over the counter) while on atenolol, as adverse effects can occur.

Atenolol brand names

  • Tenormin

What is atenolol prescribed for?

Atenolol is a beta-1-selective adrenergic antagonist, also known as a beta-blocker, which is approved by the US Food and Drug Administration (FDA) for use in the treatment of hypertension, angina pectoris, and acute myocardial infarction [1].

Atenolol is also sometimes prescribed off-label, which means that it is not an FDA-approved use, but has been deemed necessary for treatment by a medical profession. It can be prescribed off-label for the treatment of other heart conditions, migraines, alcohol withdrawal, and to reduce the symptoms of anxiety [1][2].

Atenolol has been found to be somewhat effective in relieving symptoms that occur within the context of several anxiety disorders, posttraumatic stress disorder (PTSD), social phobia, and performance anxiety [3][4][5]. However, it has not been approved by the FDA for this purpose as there is limited research into its safety and effectiveness.

Although it has been found to reduce symptoms such as shaking, sweating, and increased heart rate, while causing few side effects [3][4], there has also been research to suggest that atenolol may cause depression [6] and could create a risk of potential harm to the heart [5][7].

At present, there are several medications prescribed as anti-anxiety treatments, both approved and off-label, including antidepressants, benzodiazepines, and beta-blockers, but none have been found to be entirely effective or without side effects, and the response to the medications varies from person to person [8].

As such, further research is required to find the most effective treatment for anxiety disorders, as well as to determine the effectiveness and safety of beta-blockers, such as atenolol, for this use.

How does atenolol work?

Atenolol works by preventing activity of certain receptors in the heart, thereby reducing blood pressure and heart rate [1][2]. As such, it is an effective treatment for many heart conditions, but also helps to reduce some of the symptoms experienced with anxiety disorders and panic attacks.

While atenolol may help to reduce some of the unpleasant symptoms of anxiety, allowing improvements in daily, social, or professional functioning, it does not cure the mental effects or causes of anxiety.

How is atenolol usually taken?

Atenolol is available as a tablet in 25mg, 50mg, and 100mg strengths. Oral tablets should be swallowed whole without breaking or crushing.

For the treatment of heart conditions, atenolol is typically started with a daily dose of 25-50mg, which is then increased to 100mg, to be taken as one or two doses. This can be increased up to a maximum of 200mg, but higher doses are not recommended [9].

For the treatment of various anxiety disorders or trauma-related mental health conditions, research suggests that a dose of between 25-200mg can be effective, which will likely be taken once per day [4]. Your dose will depend on your response to the medication and will not be increased above 200mg per day.

Your doctor will monitor your physical and mental responses to the medication, to evaluate the safety and effectiveness of your treatment. They may alter your initial dose depending on your response to the medication to ensure you are prescribed the lowest therapeutic dose, in order to reduce the risk of side effects.

It is important to take your medication exactly as prescribed by your doctor, never taking more or less than is prescribed, or intentionally skipping doses, as this could cause adverse effects.

If you miss a dose, take the medication as soon as possible, or if it is close to the next dosage time, skip the missed dose. Never take double your prescribed dose in one go, as this may increase the risk of side effects or overdose.

Because of the impact that atenolol has on the heart, suddenly stopping this medication can potentially cause serious heart issues [9]. If your doctor advises that you come off this medication, they will likely reduce your prescription slowly, to prevent this.

How long does atenolol stay in your system?

After your first dose of atenolol, the medication will begin working within a few hours. When you stop taking atenolol, the medication will entirely leave your system in 1-2 days, although you may continue to feel some of its effects for up to a week [1][9].

Atenolol side effects

When you start taking a new medication, you may experience some common side effects. They will likely reduce within the first week or two, but if they continue or become problematic, consult with your doctor, as you may need a reduced dose or change of medication.

Common side effects of atenolol include [9][10]:

  • Stomach upset, including constipation, diarrhea, nausea, or vomiting
  • Feeling dizzy or lightheaded
  • Tiredness and drowsiness
  • Headache
  • Confusion

Serious side effects of atenolol are less common but may still occur. Contact your doctor immediately if you experience any of the following:

  • Shortness of breath
  • Swelling of the hands, legs, or feet
  • Fainting
  • Rash or hives
  • Changes in vision
  • Depression

Atenolol precautions

It is important that your doctor is aware of any past or present mental health conditions you have experienced, to enable safe monitoring of your medical condition while on this medication, or to decide if it is safe for you.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.

Because of the potential effects of the medication, it may not be safe for you to take atenolol if you have experienced asthma or any other lung, heart, or kidney diseases, circulation issues, or an overactive thyroid [10].

While you are taking this medication, particularly at the beginning of your treatment, your doctor will closely monitor your blood pressure, pulse, and respiratory rate, to ensure your safety and mitigate any potential risks to your health.

Atenolol reduces anxiety symptoms such as flushing, sweating, and dizziness, which may also be crucial indicators of hypoglycemia, so it may not be an appropriate medication for you if you have diabetes [9].

Ensure you discuss with your doctor any allergies you experience, as atenolol can worsen allergic reactions and may reduce the effectiveness of allergy treatment [10].

Inform your doctor if you are pregnant or planning to get pregnant, as atenolol can potentially cause developmental harm or heart issues in your fetus. Your doctor will inform you of these risks so you can make an informed decision about your treatment. It is advised to only use atenolol if the benefits of this treatment outweigh the risks [9].

Inform your doctor if you are breastfeeding, as atenolol may be excreted in breast milk and cause a risk to your baby. As such, if you are breastfeeding it should be used with caution, and it is advised to monitor your baby for any unusual changes in their physical or mental health. Using alternative medications may be advisable [1].

Atenolol can make you feel drowsy, particularly when you begin your treatment. As such, it is advised not to drive until you know how atenolol will affect you and it is safe to do so.

Atenolol interactions

Some medications can interact with atenolol, potentially reducing the effectiveness of your medication or increasing the risk of side effects. This includes calcium channel blockers, anti-inflammatory drugs, medications for blood pressure and other heart conditions, sedatives, tranquilizers, and other mental health medications such as antipsychotics [10].

Always discuss your medications and potential drug interactions with your doctor prior to starting a new treatment.

Atenolol storage

Always keep all medications out of reach of children.

Store atenolol in its original packaging, in airtight containers, and at room temperature (68-77°F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the trash, as this can create unnecessary risks.

What to do if you overdose on atenolol

If you overdose on atenolol, call a medical professional, or Poison Control on 1-800-222-1222, or in case emergency medical attention is required, call 911. Symptoms of an atenolol overdose include irregular or slow heart rate, trouble breathing, seizure, and heart failure.

Frequently asked questions about atenolol

Is atenolol better than metoprolol?

Atenolol and metoprolol are both beta-blockers that can be used off-label to treat anxiety. Although research on this use is limited, both have been found to be effective at reducing certain symptoms of anxiety [11].

However, metoprolol has a shorter half-life than atenolol, which means that it must be taken more often throughout the day to produce the same effect [12]. As such, many find atenolol to be preferable.

Resources
  1. Rehman, B., Sanchez, D.P., & Shah, S. (2022). Atenolol. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539844/
  2. National Health Service. (Reviewed 2022). Atenolol. NHS. Retrieved from https://www.nhs.uk/medicines/atenolol/about-atenolol/
  3. Gorman, J.M., Liebowitz, M.R., Fyer, A.J., Campeas, R., & Klein, D.F. (1985). Treatment of Social Phobia with Atenolol. Journal of Clinical Psychopharmacology, 5(5), 298–301. Retrieved from https://doi.org/10.1097/00004714-198510000-00009
  4. Armstrong, C., & Kapolowicz, M.R. (2020). A Preliminary Investigation on the Effects of Atenolol for Treating Symptoms of Anxiety. Military Medicine, 185(11-12), e1954–e1960. Retrieved from https://doi.org/10.1093/milmed/usaa170
  5. Peet, M., & Ali, S. (1986). Propranolol and Atenolol in the Treatment of Anxiety. International Clinical Psychopharmacology, 1(4), 314–319. Retrieved from https://doi.org/10.1097/00004850-198610000-00005
  6. Bornand, D., Reinau, D., Jick, S.S., & Meier, C.R. (2022). β-Blockers and the Risk of Depression: A Matched Case-Control Study. Drug Safety, 45(2), 181–189. Retrieved from https://doi.org/10.1007/s40264-021-01140-5
  7. Hayes, P.E., & Schulz, S.C. (1987). Beta-Blockers in Anxiety Disorders. Journal of Affective Disorders, 13(2), 119–130. Retrieved from https://doi.org/10.1016/0165-0327(87)90017-6
  8. Garakani, A., Murrough, J.W., Freire, R.C., Thom, R.P., Larkin, K., Buono, F.D., & Iosifescu, D.V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in Psychiatry, 11, 595584. Retrieved from https://doi.org/10.3389/fpsyt.2020.595584
  9. AstraZeneca Pharmaceuticals LP. (2011). Tenormin (Atenolol) Tablets. Access FDA. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018240s031lbl.pdf
  10. American Society of Health-System Pharmacists, Inc. (Revised 2017). Atenolol. MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a684031.html
  11. Chaturvedi, S.K. (1985). Efficacy of Metoprolol in Anxiety Disorders. Indian Journal of Psychological Medicine, 8, 60-63. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/0975156419850116
  12. Nilsson, O.R., Atterhög, J.H., Castenfors, J., Jorfelt, L., Karlberg, B.E., Thulin, T., Tolagen, K., Wettre, S., & Ohman, K.P. (1984). A Comparison of 100 mg Atenolol and 100 mg Metoprolol Once a Day at Rest and During Exercise in Hypertensives. Acta Medica Scandinavica, 216(3), 301–307. Retrieved from https://doi.org/10.1111/j.0954-6820.1984.tb03808.x
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Naomi Carr
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Published: Feb 20th 2023, Last edited: Oct 16th 2023

Morgan Blair
Medical Reviewer Morgan Blair MA, LPCC

Meet Morgan Blair, our accomplished medical reviewer. Morgan is a licensed therapist with a master’s degree in clinical mental health counseling from Northwestern University.

Content reviewed by a medical professional. Last reviewed: Feb 20th 2023
Medical Reviewer Medical Reviewer:
Morgan Blair
Last reviewed: Feb 20th 2023 Morgan Blair

MA, LPCC