Aveten Special Precautions

ATENOLOL as with other beta- blockers: Should not be withdrawn abruptly. The dosage should be withdrawn gradually over a period of 7-14 days, to facilitate a reduction in beta-blocker dosage. Patients should be followed during withdrawal, especially those with ischaemic heart disease.
When a patient is scheduled for surgery, and a decision is made to discontinue beta- blocker therapy, this should be done at least 24 hours prior to the procedure. The risk- benefit assessment of stopping beta- blockade should be made for each patient. If treatment is continued, an anaesthetic with little negative inotropic activity should be selected to minimise the risk of myocardial depression. The patient may be protected against vagal reactions by intravenous administration of atropine.
Although contraindicated in uncontrolled heart failure , may be used in patients whose signs of heart failure have been controlled. Caution must be exercised in patients whose cardiac reserve is poor.
May increase the number and duration of angina attacks in patients with Prinzmetal's angina due to unopposed alpha- receptor mediated coronary artery vasoconstriction. ATENOLOL is a beta1- selective beta- blocker; consequently, its use may be considered although utmost caution must be exercised.
Although contraindicated in severe peripheral arterial circulatory disturbances, may also aggravate less severe peripheral arterial circulatory disturbances.
Due to its negative effect on conduction time, caution must be exercised if it is given to patients with first-degree heart block.
May mask the symptoms of hypoglycaemia, in particular, tachycardia.
May mask the signs of thyrotoxicosis.
Will reduce heart rate as a result of its pharmacological action. In the rare instances when a treated patient develops symptoms which may be attributable to a slow heart rate and the pulse rate drops to less than 50-55 bpm at rest, the dose should be reduced.
May cause a more severe reaction to a variety of allergens when given to patients with a history of anaphylactic reaction to such allergens. Such patients may be unresponsive to the usual doses of adrenaline ( epinephrine) used to treat the allergic reactions.
May cause a hypersensitivity reaction including angioedema and urticaria.
Should be used with caution in the elderly, starting with a lesser dose.
Since ATENOLOL is excreted via the kidneys, dosage should be reduced in patients with a creatinine clearance of below 35 ml/min/1.73m².
Although cardioselective (beta1) beta- blockers may have less effect on lung function than non-selective beta-blockers, as with all beta-blockers, these should be avoided in patients with reversible obstructive airways disease, unless there are compelling clinical reasons for their use. Where such reasons exist, ATENOLOL may be used with caution. Occasionally, some increase in airways resistance may occur in asthmatic patients however, and this may usually be reversed by commonly used dosage of bronchodilators such as salbutamol or isoprenaline. The label and patient information leaflet for this product state the following warning: "If you have ever had asthma or wheezing, you should not take this medicine unless you have discussed these symptoms with the prescribing doctor".
As with other beta-blockers, in patients with a phaeochromocytoma, an alpha-blocker should be given concomitantly.