The other day, a friend of mine was telling me that he was worried about stopping Atenolol. He didn’t know how to do it properly. With many frightening withdrawal stories, many people are anxious about stopping a drug.
So, it is quite a common query, ‘How to stop taking atenolol safely’. The quick answer to that is weaning off Atenolol is the safe way. You can do this by halving the dose every week until you reach a low dose. Then you can stop taking it altogether.
But why do you have to wean off the drug? And what happens if you suddenly stop? If these queries are in your mind, you’re in the right place. Let’s dive deeper into this drug so that you will understand how you can stop taking Atenolol.
Table of Content
Atenolol: What Is It Exactly?
Atenolol is a popular antihypertensive (blood-pressure-reducing) drug. It falls under the category of beta blockers. Other popular beta blockers include Propranolol, Timolol, Betaxolol, Bisoprolol, Levobunolol, etc.
Atenolol was first patented for use in 1969. So this is a drug that’s been well-tested. It is quite an effective antihypertensive. So, it is popular today.
How Does Atenolol Work?
As the name suggests, beta blockers block the beta receptors. Your cells have many receptors on their surface. The beta receptor is one of those receptors. Chemicals like norepinephrine and epinephrine (the flight or flight hormone) can activate these receptors.
The beta receptors are present in many cells throughout your body. But they are more in your heart, nerve terminals, kidneys, lungs, etc. Epinephrine (adrenaline) can activate these receptors. This causes increased heart rate, blood pressure, water storage by kidneys, etc.
If you take a beta-blocking drug, these actions are reversed. This is how your heart rate and blood pressure are reduced.
Atenolol Uses: What Is Atenolol Used For?
The most popular use of Atenolol is as an antihypertensive. It can reduce blood pressure and prevent the complications of high blood pressure. This drug is also used for:
- Ischemic heart disease: These include various forms of angina and myocardial infarction. Doctors use this drug for the long-term management of these conditions. Atenolol can reduce further attacks of angina and improve exercise tolerance.
- Cardiac arrhythmias: Beta blockers are effective in various arrhythmias. It can reduce the heart rates in supraventricular, ventricular tachycardia, atrial fibrillation, etc. They can reduce the frequency of arrhythmia as well. This is especially true for those who had previous heart attacks.
- Heart failure: In acute heart failure, beta-blockers should not be used. However, after the acute stage, beta blockers are very helpful. Trials have shown that beta-blockers can increase the lifespan of heart failure patients. Researchers believe that this is due to the positive impact on heart remodeling.
- Other uses: Atenolol plays a beneficial role in the followings:
- obstructive cardiomyopathy
- preventing stroke
Atenolol is mainly available in an oral tablet form. These tablets come with different strengths or concentrations of the drug. The available forms include 25 mg, 50 mg, and 100 mg. Patients need different amounts depending on their disease, age, kidney functions, etc.
For hypertension, the dose is around 50 to 100 mg a day. It’s better to start with a low dose (25 or 50 mg). If it is not effective, the doctor can switch to a higher dose.
For angina and myocardial infarction, the dose is almost the same. However, 200 mg may be needed at times. The maximum dose of Atenolol is 200 mg.
The pediatric dose for Atenolol is around 1 mg/kg/day.
Your body excretes Atenolol through your kidneys. If you have a kidney disease, you may need a lower dose. So you should inform your doctor in case you have such a condition.
How Long Does It Take for Atenolol to Work?
You may be wondering when the effects of Atenolol will kick in. The answer is that it depends on your condition. Atenolol can reduce blood pressure in a matter of hours. However, it might take about a week or two to achieve the complete effect.
Your doctor will measure your blood pressure in your follow-up visits. This can ensure whether or not Atenolol is working.
In the case of myocardial infarction and angina, the effects are more long-term. So it is difficult to point out when exactly the effect kicks in.
If you’re suffering from anxiety or migraine, Atenolol may work in a few hours. But it may take longer in some cases too. So, it’s best to stick to this drug if your doctor has prescribed it.
How to Stop Taking Atenolol Safely
Tapering off a drug is the safest way to discontinue a drug. The same goes for beta-blockers like Atenolol. If your doctor advises you to stop taking Atenolol, they might wean it off. This minimizes the chance of a withdrawal reaction.
The withdrawal schedule depends on the dose and duration of the drug regimen. If you’ve been taking a low dose for a short time, there’s no need to taper. But for larger doses, it’s safe to taper off.
You can try halving your dose every one to two weeks to taper off. Let’s understand that better with an example. Say you’ve been taking Atenolol 200 mg daily. So, for the first one or two weeks, you’ll take 100 mg of Atenolol daily. After that, you’ll reduce it to 50 mg. And after that, you can stop the drug altogether.
But Why Do You Need to Taper off Atenolol?
Every box of Atenolol comes with a warning. It says that Atenolol shouldn’t be abruptly stopped. But why is it so? This is because of the withdrawal effects.
As you’ve already read, Atenolol blocks the effect of adrenaline on beta receptors. This drug is foreign to your body. So, your body tries to adapt to this blocking effect. It does so by increasing the number of beta receptors. This is called ‘receptor upregulation’.
If you take Atenolol regularly, this isn’t a problem. That’s because Atenolol blocks most of the receptors. So, your body functions stay the same even with more receptors.
However, that isn’t the case if you suddenly stop taking Atenolol. In that case, the blockade effect of Atenolol is abruptly stopped. So, adrenaline can have its full effect on a large number of receptors.
Hence there are withdrawal symptoms due to this excess effect. But this isn’t the case if you gradually stop Atenolol. Your body will reduce the number of beta receptors as you reduce Atenolol. So, the chance of withdrawal symptoms is minimum.
Atenolol Withdrawal Symptoms
Withdrawal symptoms of Atenolol vary from person to person. Some may have exaggerated symptoms. Others may have no symptoms at all. However, withdrawal is more dangerous among those with heart disease.
After stopping Atenolol, side effects are:
- Chest pain
- Sudden elevation of blood pressure
- Thyroid storm in case of those suffering from thyrotoxicosis
- Higher risk of exacerbation of angina
- Myocardial infarction
- Various arrhythmias, like Ventricular tachycardia
The last three withdrawal effects are mainly for those with previous heart attacks or angina.
Withdrawal of Atenolol vs other Beta-blockers
All beta-blockers aren’t the same when it comes to withdrawal. You’ll be lucky if you’ve been taking Atenolol. That’s because some studies claim that Atenolol is safer for withdrawal than other beta-blockers.
The withdrawal effects you’ve just read about may occur with Atenolol withdrawal. But it’s not as frequent or as severe as the other beta-blockers. Propranolol and Metoprolol have more severe withdrawal effects.
Atenolol side effects
Like any other drug, Atenolol has its fair share of side effects. But most of these aren’t that severe. The few severe ones are rare. That’s why Atenolol is such a popular drug. Some of the common side effects are:
- Skin rash
- Difficulty falling asleep
In rare cases, there may be some serious side effects. These include:
- Heart failure – Beta-blockers can cause heart failure if too much is given at once. These drugs are very helpful to prevent complications of heart failure. So, doctors prescribe them for heart failure patients. However, too much can backfire and cause an acute attack of heart failure.
- Postural hypotension – When you stand up from lying, there is a slight change in your blood pressure. This is so you can maintain proper circulation to your brain.
Beta-blockers like Atenolol can prevent this increase in pressure. So, if you stand up suddenly, you might feel dizzy. This is due to less blood flow to your brain.
- Psychiatric issues – In rare cases, beta-blockers can cause problems with mental health. In this respect, other beta-blockers like propranolol are more responsible. But there is a small probability with Atenolol as well. The common problems that might occur are depression, psychosis, etc.
- Exacerbation of asthma and COPD – Doctors try to avoid beta-blockers among asthma and COPD (Chronic obstructive pulmonary disease) patients. This is because these drugs can narrow your airways. For people with normal lung function, this isn’t a problem.
Asthma and COPD can make the airways narrow. So, using beta-blockers will cause further narrowing. They will also prevent drugs like Albuterol from working (as albuterol activates beta receptors).
However, Atenolol is safer than other beta-blockers in this case. That’s cause Atenolol works mainly on the heart. But still, there should be adequate caution while using this.
- Exacerbation of psoriasis – Many drugs can make psoriasis worse. Beta-blockers are important among them. So, you should inform your doctor if you notice skin lesions while on Atenolol.
- BRASH syndrome – This is a rare but severe side effect of Atenolol. The term BRASH is an acronym. It comprises Bradycardia, Renal failure, AV-nodal block, Shock, and Hyperkalemia.
- Others: Other rare side effects include
If you have difficulties with Atenolol, it’s best to contact your doctor.
Can Atenolol Be Stopped?
Yes, you can stop taking Atenolol. But you should speak to your doctor about it. If you’re experiencing side effects, then your doctor can give you another drug.
There are other beta-blockers. And depending on your specific condition, other drugs are available too. But you shouldn’t stop it abruptly. It’s best to gradually wean it off.
What Is a Good Replacement for Atenolol?
You shouldn’t replace Atenolol with another drug without informing your doctor. That being said, there are other replacement drugs depending on your conditions.
Replacement beta-blockers include Metoprolol, Bisoprolol, Betaxolol, Propranolol, Nadolol, Pindolol, etc. For anxiety, other drugs like benzodiazepines, sedatives, antidepressants, etc. are available. Other antihypertensives are:
- ACEI (captopril, enalapril)
- ARB (losartan, valsartan)
- Ca channel blockers (Amlodipine, verapamil, diltiazem)
When Should You Avoid Atenolol?
There are a few conditions where doctors will not prescribe Atenolol. These are:
- Heart problems: These include heart block, bradycardia, shock, and acute heart failure.
- Asthma and COPD: The symptoms of asthma and COPD can flare up with beta-blockers.
- Diabetes Mellitus: Beta-blockers can mask the symptoms of hypoglycemia. So, doctors may avoid it if you have diabetes mellitus.
- Pregnancy and breastfeeding: There is a possibility that this drug can cause harm to the baby.
Is Atenolol Good for the Heart?
Yes, Atenolol is good for the heart if your doctor has prescribed it for you. This drug can have a positive effect on heart remodeling. So, the lifespan is increased for those who had heart attack, heart failure, angina, etc.
Atenolol also prevents cardiac arrhythmias. However, Atenolol may worsen some particular heart conditions. These include heart block, acute heart failure, and bradycardia. So, you shouldn’t take Atenolol without consulting with your doctor.
Hopefully, this article answered your question, ‘How to stop taking Atenolol safely’. Atenolol is a safe drug. But stopping it suddenly may result in withdrawal symptoms. And they can be fatal if you already have a heart condition.
You can avoid all of this by stopping the drug gradually. You should discuss with your physician how to stop this drug. With your doctor’s advice and a weaning schedule, you can come off Atenolol safely.