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| tenormin tenormin sudden death | tenormin withdrawal Re: tenormin and withdrawal symptoms and/or risks Questions in The Heart Forum are being answered by doctors from The Cleveland Clinic Heart Center, consistently ranked the #1 Heart Center in America. Subject: Re: tenormin and withdrawal symptoms and/or risks Forum: The Heart Forum Topic Area: Mitral Valve Posted by dave on June 18, 1999 at 18:04:17My name is Dave and I am 38 years old and have been diagonosed with mitral valve. I have been on tenormin for the last 15 years. Over the last six months I have been winded and unable to get my heart rate much over 70 even while exercising. Recently I went for a full battery of tests and all was fine with my heart. I cut my intake of tenormin from 25mg to 12 1/2mg and feel much better(daily dose). I have the energy that I had lost. My physician did not want me to cut the dose and I would like to know what side effects I should be tenormin withdrawal on the look out for? What tenormin withdrawal also is the length of time it tenormin withdrawal takes to ween one off the tenormin withdrawal medication and how should this be done?Thanks for your help.DavePosted by CCF CARIDO MD - CRC on June 21, 1999 at 09:04:59Dear Dave,Thank you for your question. Here is some general information about beta-blockers. As far as specific advice we recommend following the advice of your physician.Beta-blockers are used to treat high blood pressure, angina (chest pain), heart attacks, heart rhythm problems such as atrial fibrillation and more recently tenormin withdrawal heart failure. Potential side effects include: >10 % mental depression, tiredness, weakness, dizziness1-10% Bradycardia (slow heart rate), wheezing, irregular heart beat, reduced peripheral circulation, heartburn [Heart Forum ] [Heart Forum Archives] [ Med Help International ] If you would like to make an appointment at the Cleveland Clinic, please call 216-444-2200 or inquire online by using The Cleveland Clinic Web site. The site contains a directory of the staff that can be used to select the physician best suited to address your medical problem. The Cleveland Clinic also offers specialist consultation and tenormin withdrawal second opinion using the Internet through e-Cleveland Clinic. e-Cleveland Clinic is a new Web-based extension of tenormin withdrawal The Cleveland Clinics 80-year role as one of Americas most respected referral institutions. It provides online second opinions for patients with life-threatening and life-altering diagnoses. To request an online consultation, go to the e-Cleveland Clinic Web site. Copyright © Med Help International. All rights reserved. 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(Addiction Medicine Forum) Xanax withdrawl/tolorance (Addiction Medicine Forum) Zoloft tenormin withdrawal withdrawl (Mental Health Forum) Zoloft withdrawl (Mental Health Forum) Zyban and Alcohol Do Not Mix (Addiction Medicine Forum) [Med Help International] [Search] [Medical Forums / Message Boards] [Site Map] Revised: 7/3/2005 Tenormin tenormin withdrawal Brand name: Tenormin Pronounced: Ten-OR-min Generic name: Atenolol Why is this drug prescribed? Return to top Tenormin, a type of medication known as a beta blocker, is used in the treatment of high blood pressure, angina pectoris (chest pain, usually caused by lack of oxygen in the heart muscle due to clogged arteries), and heart attack. When used for high blood pressure it is tenormin withdrawal effective alone or combined with other high blood pressure medications, particularly with a thiazide-type tenormin withdrawal water pill (diuretic). Beta blockers decrease the force and rate of heart contractions. Occasionally doctors prescribe Tenormin for treatment of alcohol withdrawal, prevention of migraine headache, and bouts of anxiety. Most important fact about this drug Return to top If you have high blood pressure, you must take Tenormin regularly for it to be effective. Since blood pressure declines gradually, it tenormin withdrawal may be several weeks before you get the full benefit of Tenormin; and you must continue taking it even if you are feeling well. Tenormin does not cure high blood pressure; it merely keeps it under control. How should you take this medication? Return tenormin withdrawal to top Tenormin can be taken with or without food. Take it exactly as prescribed, even if your symptoms have disappeared. Try not to miss any doses, especially if you are taking Tenormin once a day. If this medication is not taken regularly, your condition may worsen. --If tenormin withdrawal you miss a tenormin withdrawal dose... Take the forgotten dose as soon as you remember. If it's within 8 hours of your next scheduled dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time. --Storage instructions... Store Tenormin at room temperature; protect from light. What side effects may occur? Return to top Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it tenormin withdrawal is safe for you to continue taking Tenormin. More common side effects may include: Dizziness, fatigue, nausea, slow heartbeat Less common or rare side effects may tenormin withdrawal include: Depression, diarrhea, difficult or labored breathing, dizziness upon standing up, drowsiness, headache, heart failure, impotence, light-headedness, low blood pressure, penile deformity, periods of poor circulation in the fingers, psoriasis-like rash, red or purple spots on the skin, rapid heartbeat, slow heartbeat, sluggishness, temporary hair loss, tiredness, vertigo, wheezing, worsening of psoriasis Why should this drug not be prescribed? Return to top If you have heart failure, inadequate blood supply to the circulatory system (cardiogenic shock), heart block (conduction disorder), or a severely slow heartbeat, you should not take this medication. You'll also need to avoid it if it gives you an allergic reaction. Special warnings about this medication Return to top If you have a history of tenormin withdrawal severe congestive heart failure, Tenormin should be used with caution. Tenormin should not be tenormin withdrawal stopped suddenly. It can cause increased chest pain and heart attack. Dosage should be gradually reduced. If you suffer from asthma, seasonal allergies, or other bronchial conditions, coronary artery disease or kidney disease, this medication should be used with caution. Ask your doctor if you should check your pulse while taking Tenormin. This medication can cause your heartbeat to become too slow. This medication may mask the symptoms of low blood sugar or alter blood sugar levels. If tenormin withdrawal you are diabetic, discuss this with your doctor. Notify your doctor or dentist that tenormin withdrawal you are taking Tenormin if you have a medical emergency, and before you have surgery or dental surgery. Tenormin may cause harm to a developing baby when taken during pregnancy. If you are pregnant or become pregnant while taking this medication, inform your doctor immediately. Possible food and drug interactions when taking this medication Return to top If Tenormin is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your tenormin withdrawal doctor before combining Tenormin with the following: Ampicillin (Omnipen, others) Calcium-containing antacids such as tenormin withdrawal Tums Calcium-blocking blood pressure drugs such as Calan and Cardizem Certain other blood pressure drugs such as reserpine (Diupres) Clonidine (Catapres) Epinephrine (EpiPen) Indomethacin (Indocin) Insulin Oral diabetes tenormin withdrawal drugs such as Micronase Quinidine (Quinidex) Special information if tenormin withdrawal you are pregnant or breastfeeding Return to top The use tenormin withdrawal of Tenormin during pregnancy may cause harm to a developing baby. If you are pregnant, become pregnant, or tenormin withdrawal plan tenormin withdrawal to become pregnant, inform your tenormin withdrawal doctor immediately. Tenormin appears in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment is finished. Recommended dosage Return to top ADULTS Hypertension The usual starting dose is 50 milligrams a tenormin withdrawal day in 1 tenormin withdrawal dose, alone or with a diuretic. Full effects should be seen tenormin withdrawal in 1 to 2 weeks. Dosage may be increased to a maximum of 100 milligrams per day in one dose. Your doctor can and may use this medication tenormin withdrawal with other high blood pressure medications. Angina Pectoris The usual starting dose is 50 milligrams in 1 dose a day. Full effects should be seen in 1 week. Dosage may be increased to a maximum of 100 milligrams tenormin withdrawal per day. In some cases, a single dose of 200 milligrams per day may be given. Dosage will be individualized by your doctor. Heart Attack This medication may be used in the acute treatment of heart attack in both injectable and tablet form. Your doctor will determine the proper dosage. CHILDREN The safety and effectiveness of Tenormin have not been established in children. OLDER ADULTS The doctor will determine the dosage for an older individual, according to his or her needs, especially in the case of reduced kidney function. Overdosage Return to top Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately. Symptoms of Tenormin overdose may include: Congestive tenormin withdrawal heart failure, constricted airways, low blood pressure, low blood sugar, slow heartbeat, sluggishness, wheezing Return to top Tenormin Tablets Drug Information Tenormin Tablets Prescription Drug Information for Consumers & Professionals Home New tenormin withdrawal Drugs Latest News Drug Interactions Pill Identification Images Forum Drugs.com - prescription drug and medicine information available on over 24,000 approved- medications and pharmaceuticals, including side effects and drug tenormin withdrawal interactions. Log-in Register Advertisement Buy a Link Now Special Offers From our sponsors Categories Allergies tenormin withdrawal & Hayfever Diabetes Gastro Center Weight Loss AIDS/HIV Cancer & Oncology Mental Health & Depression Cholesterol Hair tenormin withdrawal Loss Muscular Injuries & Arthritis Pain Relief Sexual Health Advertisement tenormin withdrawal Advanced Search Or click the tenormin withdrawal first letter of a drug name: A B C D E F G H I J tenormin withdrawal K L M N O P Q R S T U V W X Y Z PDR Drug information for TENORMIN® (AstraZeneca)Manufacturer: AstraZeneca(atenolol)ONE TABLET A DAY DESCRIPTION TENORMIN® (atenolol), a synthetic, beta 1 -selective (cardioselective) adrenoreceptor blocking agent, may be chemically described as benzeneacetamide, 4-[2'-hydroxy-3'-[(1-methylethyl) amino] propoxy]-. The molecular and structural formulas are: Atenolol (free base) has a molecular weight of 266. It is a relatively polar hydrophilic compound with a water solubility of 26.5 mg/mL at 37°C and a log partition coefficient (octanol/water) tenormin withdrawal of 0.23. It is freely soluble in 1N HCl (300 mg/mL at 25°C) and less soluble in chloroform (3 mg/mL at 25°C). TENORMIN is available as 25, 50 and 100 mg tablets for oral administration. Inactive Ingredients: Magnesium stearate, microcrystalline cellulose, povidone, sodium starch glycolate. CLINICAL PHARMACOLOGY TENORMIN is a beta 1 -selective tenormin withdrawal (cardioselective) beta-adrenergic receptor blocking agent without membrane stabilizing or intrinsic sympathomimetic (partial agonist) activities. This preferential effect is not absolute, tenormin withdrawal however, and at higher doses, TENORMIN inhibits beta 2 -adrenoreceptors, chiefly located in the bronchial and vascular musculature. Pharmacokinetics and Metabolism: In man, absorption of an oral dose tenormin withdrawal is rapid and consistent but incomplete. Approximately 50% of an oral dose is absorbed from the gastrointestinal tract, the remainder being excreted unchanged in the feces. Peak blood levels are reached between two (2) tenormin withdrawal and four (4) hours after ingestion. Unlike propranolol or metoprolol, but like nadolol, TENORMIN undergoes little tenormin withdrawal or no metabolism by the liver, and the absorbed portion is eliminated primarily by renal excretion. Over 85% of an intravenous dose is excreted in urine within 24 hours compared with tenormin withdrawal approximately 50% for an oral dose. TENORMIN also differs from propranolol in that only a small amount tenormin withdrawal (6%-16%) is bound to proteins in the plasma. This kinetic profile results in relatively consistent plasma drug levels with about a fourfold interpatient variation. The elimination half-life of oral TENORMIN is approximately 6 to 7 hours, and there is no alteration of the kinetic profile of tenormin withdrawal the drug by chronic administration. Following intravenous administration, peak plasma levels are reached within 5 minutes. Declines from peak levels are rapid (5- to 10-fold) during tenormin withdrawal the first 7 hours; thereafter, plasma levels decay with a half-life similar to that of orally administered drug. Following oral doses of 50 mg or 100 mg, both beta-blocking and antihypertensive effects persist for at tenormin withdrawal least 24 hours. tenormin withdrawal When renal function is impaired, elimination of TENORMIN is closely related to the glomerular filtration rate; significant accumulation occurs when the creatinine clearance falls below 35 tenormin withdrawal mL/min/1.73m 2 . (See DOSAGE AND ADMINISTRATION .) Pharmacodynamics: In standard animal or human pharmacological tests, beta-adrenoreceptor blocking activity of TENORMIN has been demonstrated by: (1) reduction in resting and exercise heart rate and cardiac output, (2) reduction of systolic and diastolic blood pressure tenormin withdrawal at rest and on exercise, (3) inhibition of isoproterenol induced tachycardia, and (4) reduction in reflex orthostatic tachycardia. A significant beta-blocking effect of TENORMIN, as measured by reduction of exercise tachycardia, is apparent within one hour following oral administration of a single dose. This effect is maximal tenormin withdrawal at about 2 to 4 hours, and persists for at least 24 hours. Maximum reduction in exercise tachycardia occurs within 5 minutes of an intravenous dose. For both orally and intravenously administered drug, the duration of action is dose related and also bears a linear relationship to the logarithm of plasma TENORMIN concentration. The effect on exercise tenormin withdrawal tachycardia of a single 10 mg tenormin withdrawal intravenous dose is largely dissipated by 12 hours, whereas beta-blocking activity of single oral doses tenormin withdrawal of 50 mg and 100 mg is still evident beyond 24 hours following administration. However, as has been shown tenormin withdrawal for all beta-blocking tenormin withdrawal agents, the antihypertensive effect does not appear to be related to plasma level. In normal subjects, the beta 1 selectivity of TENORMIN has been shown by its tenormin withdrawal reduced ability to reverse the beta 2 -mediated vasodilating effect of isoproterenol as compared to equivalent beta-blocking doses of propranolol. In asthmatic patients, a dose of TENORMIN producing a greater effect on resting heart rate than propranolol resulted in much less increase in airway resistance. In a placebo controlled comparison of tenormin withdrawal approximately equipotent oral doses of several beta blockers, TENORMIN produced a significantly smaller decrease of FEV 1 than nonselective beta blockers such as propranolol tenormin withdrawal and, unlike those agents, did not inhibit bronchodilation in response to isoproterenol. Consistent with its negative chronotropic effect due to beta blockade of the SA node, TENORMIN increases sinus cycle length and sinus node recovery time. Conduction in the AV node is also prolonged. TENORMIN is devoid of membrane stabilizing activity, and increasing the dose well beyond that producing beta blockade does not further depress myocardial contractility. Several studies have demonstrated a moderate (approximately 10%) increase in stroke volume tenormin withdrawal at rest and during exercise. In controlled clinical trials, TENORMIN, given as a single daily oral dose, was an effective antihypertensive agent providing 24-hour reduction of blood pressure. TENORMIN has been studied in combination with thiazide-type diuretics, and the blood pressure effects of the combination are approximately additive. TENORMIN is also compatible with methyldopa, hydralazine, and prazosin, tenormin withdrawal each combination resulting tenormin withdrawal in a larger fall in blood pressure than with the single agents. The dose range tenormin withdrawal of TENORMIN is narrow and increasing the dose beyond 100 mg once daily is not associated with increased antihypertensive effect. The mechanisms of the antihypertensive effects of beta-blocking agents have not been established. Several possible mechanisms have been proposed and tenormin withdrawal include: (1) competitive antagonism of catecholamines at peripheral (especially cardiac) adrenergic neuron sites, leading to decreased cardiac output, (2) a central effect leading to reduced sympathetic outflow to tenormin withdrawal the periphery, and (3) suppression of renin activity. The results from long-term studies have not tenormin withdrawal shown any diminution of the antihypertensive efficacy of TENORMIN with prolonged use. By blocking the positive chronotropic and inotropic effects of catecholamines and by decreasing blood pressure, atenolol generally reduces the oxygen requirements of the heart at any given level of effort, making it useful for tenormin withdrawal many patients in the long-term management of angina pectoris. On the other hand, atenolol increase oxygen requirements by increasing left ventricular fiber length and end diastolic pressure, particularly in patients with heart failure. In a multicenter clinical trial (ISIS-1) conducted in 16,027 patients with suspected myocardial infarction, patients presenting within 12 hours (mean = 5 hours) after the onset of pain were randomized to tenormin withdrawal either conventional therapy plus TENORMIN (n = 8,037), or conventional therapy alone (n = 7,990). Patients with a heart rate of < 50 bpm or systolic blood pressure < 100 mm Hg, or with other contraindications to tenormin withdrawal beta blockade were excluded. Thirty-eight percent of each group were treated within 4 hours of onset of pain. tenormin withdrawal The mean time from onset of pain to entry was 5.0 ± 2.7 hours in both groups. Patients in the TENORMIN group were to receive TENORMIN I.V. Injection 5-10 mg given over 5 minutes plus TENORMIN Tablets 50 mg every 12 hours orally on the first study day (the first oral dose administered about 15 minutes after the IV dose) followed by either TENORMIN Tablets 100 mg once daily or tenormin withdrawal TENORMIN Tablets 50 mg twice daily on days 2-7. The groups were similar tenormin withdrawal in demographic and medical history characteristics and in electrocardiographic evidence of myocardial infarction, bundle branch block, and first degree atrioventricular block at entry. During the treatment period (days 0-7), the vascular mortality rates were tenormin withdrawal 3.89% in the TENORMIN group (313 deaths) and 4.57% in the control group (365 deaths). This absolute difference in rates, 0.68%, is statistically significant at the P < 0.05 level. The tenormin withdrawal absolute difference translates into a proportional reduction of 15% (3.89-4.57/4.57 = -0.15). tenormin withdrawal The 95% confidence limits are 1%-27%. Most of the difference was attributed to mortality in days 0-1 (TENORMIN - 121 deaths; control - 171 deaths). Despite the large size of the ISIS-1 trial, it is not possible to identify clearly subgroups of patients most likely tenormin withdrawal or least likely to benefit from early treatment with atenolol. Good clinical judgment suggests, however, that patients who are dependent on sympathetic stimulation for maintenance of adequate cardiac output and blood pressure are not good candidates for beta blockade. Indeed, the trial protocol reflected that judgment by excluding patients with blood pressure consistently below 100 mm Hg systolic. The overall results tenormin withdrawal of the study are compatible with the possibility that patients with borderline blood pressure (less than 120 mm Hg systolic), especially if over 60 years of age, are less likely to benefit. The mechanism through which atenolol improves survival in patients with definite or suspected acute myocardial infarction is unknown, as is the case for other beta blockers in the postinfarction setting. Atenolol, in addition to its effects on survival, has shown other clinical benefits including reduced frequency of ventricular premature beats, reduced chest pain, and reduced enzyme elevation. Atenolol Geriatric Pharmacology: In general, elderly patients present higher atenolol plasma levels with total clearance values about 50% lower than younger subjects. The half-life is markedly longer in the elderly compared to younger subjects. The reduction in atenolol clearance follows the general trend that the elimination of renally excreted drugs is decreased tenormin withdrawal with increasing age. INDICATIONS AND USAGE Hypertension: TENORMIN is indicated in the management of hypertension. It may be used alone or concomitantly with other antihypertensive agents, particularly with a thiazide-type diuretic. Angina Pectoris Due to Coronary Atherosclerosis: TENORMIN is indicated for the long-term management of patients with angina pectoris. Acute Myocardial Infarction: TENORMIN is indicated in the management of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality. Treatment can be initiated as soon as the patient's clinical condition allows. (See DOSAGE AND ADMINISTRATION , CONTRAINDICATIONS , and WARNINGS .) In general, there is no basis for treating patients like those who were excluded from the ISIS-1 trial (blood pressure less than 100 mm Hg systolic, heart rate less than 50 bpm) or have other reasons to avoid beta blockade. As noted above, some subgroups (eg, elderly patients with systolic blood tenormin withdrawal pressure below 120 mm Hg) seemed less likely to benefit. CONTRAINDICATIONS TENORMIN is contraindicated in sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure. (See WARNINGS .) TENORMIN is contraindicated in those patients with a history of hypersensitivity to the atenolol or any of the drug tenormin withdrawal product's components. WARNINGS Cardiac Failure: Sympathetic tenormin withdrawal stimulation is necessary in supporting circulatory function in congestive heart failure, and beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure. In patients who have congestive heart failure controlled by digitalis and/or diuretics, TENORMIN should be administered cautiously. Both digitalis and atenolol slow tenormin withdrawal AV conduction. In patients with acute myocardial infarction, cardiac failure which is not promptly and effectively tenormin withdrawal controlled by tenormin withdrawal 80 mg of intravenous furosemide or equivalent therapy is a contraindication to beta-blocker treatment. In Patients Without a History of Cardiac Failure: Continued depression of the myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac tenormin withdrawal failure. At the first sign or symptom of impending cardiac failure, patients should be treated appropriately according to currently recommended guidelines, and the response observed tenormin withdrawal closely. If cardiac failure continues despite adequate treatment, TENORMIN should be withdrawn. (See DOSAGE AND ADMINISTRATION ) Cessation of Therapy with TENORMIN: Patients with coronary artery disease, who are being treated with TENORMIN, should be advised against abrupt discontinuation of therapy. Severe exacerbation of angina and the occurrence of myocardial infarction and ventricular arrhythmias have been reported in angina patients following the abrupt tenormin withdrawal discontinuation of therapy with beta blockers. The last two complications may occur with or without preceding exacerbation of the angina pectoris. As with other beta blockers, when discontinuation of TENORMIN is planned, the patients should be carefully observed and advised to limit physical activity to a minimum. If the angina worsens or acute coronary insufficiency develops, it is recommended that TENORMIN be promptly reinstituted, at least temporarily. Because coronary artery disease is common and may be unrecognized, it may be prudent not tenormin withdrawal to tenormin withdrawal discontinue TENORMIN therapy abruptly even in tenormin withdrawal patients treated only for hypertension. (See DOSAGE AND ADMINISTRATION .) Concomitant Use of Calcium Channel Blockers: Bradycardia and heart block can occur and the left ventricular end tenormin withdrawal diastolic pressure can rise when beta-blockers are administered with verapamil or diltiazem. Patients with preexisting conduction abnormalities or left ventricular dysfunction tenormin withdrawal are particularly susceptible. (See PRECAUTIONS .) Bronchospastic Diseases: PATIENTS WITH BRONCHOSPASTIC DISEASE SHOULD, IN GENERAL, NOT tenormin withdrawal RECEIVE BETA BLOCKERS. Because of its relative beta 1 selectivity, however, TENORMIN may be used with caution in patients tenormin withdrawal with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Since beta 1 selectivity is not absolute, the lowest possible dose of TENORMIN should be used with therapy initiated at 50 mg and a beta 2 -stimulating agent (bronchodilator) should be made available. If dosage must be increased, dividing the dose should be considered in order to achieve lower peak blood levels. Anesthesia and Major Surgery: It is tenormin withdrawal not advisable to withdraw beta-adrenoreceptor blocking drugs prior to surgery in the majority of patients. However, care should be taken when using anesthetic agents such as those which may depress the myocardium. Vagal dominance, if it occurs, may be corrected with atropine (1-2 mg IV). TENORMIN, like other beta blockers, is a competitive inhibitor of beta-receptor agonists and its effects on the heart can be reversed by administration of such agents: eg, dobutamine or isoproterenol with caution (see section on OVERDOSAGE ). Diabetes and Hypoglycemia: TENORMIN should be used with caution in diabetic patients if a beta-blocking agent is required. Beta blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected. At recommended doses TENORMIN tenormin withdrawal does not potentiate insulin-induced hypoglycemia and, unlike nonselective beta blockers, does not delay recovery of blood glucose to normal levels. Thyrotoxicosis: Beta-adrenergic blockade may tenormin withdrawal mask certain tenormin withdrawal clinical signs (eg, tachycardia) of hyperthyroidism. Abrupt withdrawal of beta blockade might precipitate a tenormin withdrawal thyroid storm; therefore, patients suspected of developing thyrotoxicosis from whom TENORMIN therapy is to be withdrawn should be monitored closely. (See DOSAGE AND ADMINISTRATION .) Untreated Pheochromocytoma: TENORMIN should not be given to patients tenormin withdrawal with untreated pheochromocytoma. Pregnancy and Fetal Injury: Atenolol can cause fetal harm when administered to a pregnant woman. tenormin withdrawal Atenolol crosses the placental barrier and appears in tenormin withdrawal cord blood. Administration of atenolol, starting in the second trimester of pregnancy, has been associated with the birth of infants that are small for gestational age. No studies have been performed on the use of atenolol in the first trimester and the possibility of fetal injury cannot be excluded. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should tenormin withdrawal be apprised of the potential hazard to the fetus. Atenolol has been shown to produce a dose-related increase in embryo/fetal resorptions in rats at doses equal to or greater than tenormin withdrawal 50 mg/kg/day or 25 or more times the maximum recommended human antihypertensive dose. * Although similar effects were not seen in rabbits, the compound was not evaluated in rabbits at doses above 25 mg/kg/day or 12.5 times the maximum recommended human antihypertensive dose. * *Based on the maximum dose of 100 mg/day in a 50 kg patient. Neonates born tenormin withdrawal to mothers who are receiving TENORMIN at parturition or breast-feeding may be at risk for hypoglycemia. Caution should be exercised when TENORMIN is tenormin withdrawal administered during pregnancy or to a woman who is breast-feeding (See PRECAUTIONS , Nursing Mothers ). PRECAUTIONS General: Patients already on a beta blocker must be evaluated carefully before TENORMIN is administered. Initial and subsequent TENORMIN dosages can be adjusted downward depending on clinical observations including pulse and blood pressure. TENORMIN may aggravate peripheral arterial circulatory disorders. Impaired Renal Function: The drug should be used with caution in patients with impaired renal function. (See DOSAGE AND ADMINISTRATION .) Drug Interactions: Catecholamine-depleting drugs (eg, reserpine) may have an additive effect when given with beta-blocking agents. Patients treated with TENORMIN plus a catecholamine depletor should therefore be closely observed for tenormin withdrawal evidence of tenormin withdrawal hypotension and/or marked bradycardia which may produce vertigo, tenormin withdrawal syncope, or postural hypotension. Calcium channel blockers may also have an additive effect when given with TENORMIN (See WARNINGS .) Beta blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the tenormin withdrawal two drugs are coadministered, the beta blocker should be withdrawn several days before the gradual withdrawal of clonidine. If replacing clonidine by beta-blocker therapy, the introduction of beta blockers should be delayed for several days after clonidine administration has stopped. Concomitant use of prostaglandin synthase inhibiting drugs, tenormin withdrawal eg, indomethacin, may decrease the hypotensive tenormin withdrawal effects of beta blockers. Information on concurrent usage of atenolol and aspirin is limited. Data from several studies, ie, TIMI-II, ISIS-2, currently do not suggest any clinical interaction between aspirin and beta blockers in the acute myocardial infarction setting. While taking beta blockers, patients with a history of anaphylactic reaction tenormin withdrawal to a variety of allergens may have a more severe reaction on repeated challenge, either tenormin withdrawal accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat the tenormin withdrawal allergic reaction. Carcinogenesis, Mutagenesis, Impairment of Fertility: Two long-term (maximum dosing duration of 18 or 24 tenormin withdrawal months) rat studies and one long-term (maximum dosing duration of 18 months) mouse study, each employing dose levels as high as 300 mg/kg/day or 150 times the maximum recommended human antihypertensive dose, * did not indicate a carcinogenic potential of atenolol. A third (24 month) rat study, employing doses of 500 and 1,500 mg/kg/day (250 and 750 times the maximum recommended human antihypertensive dose * ) resulted in increased incidences of benign adrenal medullary tumors in males and tenormin withdrawal females, mammary fibroadenomas in females, and anterior pituitary adenomas and thyroid parafollicular cell carcinomas in males. No evidence of a mutagenic potential of atenolol was uncovered in the dominant lethal test (mouse), in vivo cytogenetics test (Chinese hamster) or Ames test ( S typhimurium ). Fertility of male or female rats (evaluated at dose levels as high as 200 mg/kg/day or 100 times the maximum recommended human dose * ) was unaffected by atenolol administration. Animal Toxicology: Chronic studies employing oral atenolol performed in animals have revealed the occurrence of vacuolation of epithelial cells of Brunner's glands in the duodenum of both male and female dogs at all tested dose levels of atenolol (starting at 15 mg/kg/day or 7.5 times the tenormin withdrawal maximum recommended human antihypertensive dose * ) and increased incidence of atrial degeneration of hearts of male rats at 300 but not 150 mg atenolol/kg/day (150 and 75 times the maximum recommended human antihypertensive dose, * respectively). *Based on the maximum dose of 100 mg/day in a 50 kg patient. Usage in Pregnancy: Pregnancy Category D: See WARNINGS -- Pregnancy and Fetal Injury . Nursing Mothers: Atenolol is excreted in human breast milk at a ratio of 1.5 to 6.8 tenormin withdrawal when compared to the concentration in plasma. Caution should be exercised when TENORMIN is administered to a nursing woman. Clinically significant bradycardia has been reported in breast-fed infants. Premature infants, or infants with impaired tenormin withdrawal renal function, may be more likely to develop adverse effects. Neonates born to mothers who are receiving TENORMIN at parturition or breast-feeding may be at risk for hypoglycemia. Caution should be exercised when TENORMIN is administered during pregnancy or to a woman who is breast-feeding (See WARNINGS , Pregnancy and Fetal Injury ). Pediatric Use: Safety and effectiveness in pediatric patients have not been established. Geriatric tenormin withdrawal Use: Hypertension and Angina Pectoris Due to Coronary Atherosclerosis: Clinical studies of TENORMIN did not include sufficient tenormin withdrawal number of patients aged tenormin withdrawal 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater tenormin withdrawal frequency of decreased hepatic, tenormin withdrawal renal, or cardiac function, and of concomitant disease or tenormin withdrawal other drug therapy. Acute Myocardial Infarction: Of the 8,037 patients with suspected acute myocardial infarction randomized to TENORMIN in the ISIS-1 trial (See CLINICAL PHARMACOLOGY ), 33% (2,644) were 65 years of age and older. It was not possible to identify significant differences in efficacy and safety between older and younger patients; however, elderly patients with systolic blood pressure < 120 mmHg seemed less likely to benefit (See INDICATIONS AND USAGE ). In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Evaluation of patients with hypertension tenormin withdrawal or myocardial infarction should always include assessment of renal function. ADVERSE REACTIONS Most adverse effects have been mild and transient. The frequency estimates in the following table were derived from controlled studies in hypertensive patients in which adverse reactions were tenormin withdrawal either volunteered by the patient (US studies) or elicited, eg, by checklist (foreign tenormin withdrawal studies). The reported tenormin withdrawal frequency of elicited adverse effects was higher for both TENORMIN and tenormin withdrawal placebo-treated patients than when these reactions were volunteered. Where frequency of adverse effects of TENORMIN and placebo is similar, causal relationship to TENORMIN is uncertain. Volunteered (US Studies) Total - Volunteered and Elicited (Foreign + US Studies) Atenolol (n=164) % Placebo (n=206) % Atenolol (n=399) % Placebo (n=407) % CARDIOVASCULAR Bradycardia 3 0 3 0 Cold Extremities 0 0.5 12 5 Postural Hypotension 2 1 4 5 Leg Pain 0 0.5 3 1 CENTRAL NERVOUS SYSTEM/NEUROMUSCULAR Dizziness 4 1 13 6 Vertigo 2 0.5 2 0.2 Light-Headedness 1 0 3 0.7 Tiredness 0.6 0.5 26 13 Fatigue 3 1 6 5 Lethargy 1 0 3 0.7 Drowsiness 0.6 0 2 0.5 Depression 0.6 0.5 12 9 Dreaming 0 0 3 1 GASTROINTESTINAL Diarrhea 2 0 3 2 Nausea 4 1 3 1 RESPIRATORY (see Warnings ) Wheeziness 0 0 3 3 Dyspnea 0.6 1 6 4 Acute Myocardial Infarction: In a series of investigations in the treatment of acute myocardial infarction, bradycardia and hypotension occurred more commonly, as expected for any beta blocker, in atenolol-treated patients than in control patients. However, these usually responded to atropine and/or to withholding further dosage of atenolol. The incidence tenormin withdrawal of heart failure was not increased by atenolol. Inotropic agents were infrequently used. The reported frequency of these and other events occurring during these investigations is given in the following table. In a study of 477 patients, the following adverse events were reported during either intravenous and/or oral atenolol administration: Conventional Therapy Plus Atenolol (n=244) Conventional Therapy Alone (n=233) Bradycardia 43 (18%) 24 (10%) Hypotension 60 (25%) 34 (15%) Bronchospasm 3 (1.2%) 2 (0.9%) Heart Failure 46 (19%) 56 (24%) Heart Block 11 (4.5%) 10 (4.3%) BBB + Major Axis Deviation 16 (6.6%) 28 (12%) Supraventricular Tachycardia 28 (11.5%) 45 (19%) Atrial Fibrillation 12 (5%) 29 (11%) Atrial Flutter 4 (1.6%) 7 (3%) Ventricular Tachycardia 39 (16%) 52 (22%) Cardiac Reinfarction 0 (0%) 6 (2.6%) Total Cardiac Arrests 4 (1.6%) 16 (6.9%) Nonfatal Cardiac Arrests 4 (1.6%) 12 (5.1%) Deaths 7 (2.9%) 16 (6.9%) Cardiogenic tenormin withdrawal Shock 1 (0.4%) 4 (1.7%) Development of Ventricular Septal Defect 0 (0%) 2 (0.9%) Development of Mitral Regurgitation 0 (0%) 2 (0.9%) Renal Failure 1 (0.4%) 0 (0%) Pulmonary Emboli 3 (1.2%) 0 (0%) In the subsequent International Study of Infarct Survival (ISIS-1) including over 16,000 patients of whom 8,037 were tenormin withdrawal randomized to receive TENORMIN treatment, the dosage of intravenous and subsequent oral TENORMIN was either discontinued or reduced for the following reasons: Reasons for Reduced Dosage IV Atenolol Reduced Dose (<5mg) * Oral Partial Dose Hypotension/Bradycardia 105 (1.3%) 1168 (14.5%) Cardiogenic Shock 4 (.04%) 35 (.44%) Reinfarction 0 (0%) 5 (.06%) Cardiac Arrest 5 (.06%) 28 (.34%) Heart Block (> first degree) 5 (.06%) 143 (1.7%) Cardiac Failure 1 (.01%) 233 (2.9%) Arrhythmias 3 (.04%) 22 (.27%) Bronchospasm 1 (.01%) 50 (.62%) *Full dosage was 10 tenormin withdrawal mg and some patients received less than 10 mg but more than 5 mg. During postmarketing experience with TENORMIN, the following have been reported in temporal relationship to the use of the drug: elevated liver enzymes and/or bilirubin, hallucinations, headache, impotence, Peyronie's disease, postural hypotension which may be associated with syncope, psoriasiform rash or exacerbation of tenormin withdrawal psoriasis, psychoses, purpura, reversible alopecia, thrombocytopenia, visual disturbances, sick sinus syndrome, and dry mouth. TENORMIN, like other beta-blockers, has been associated with the development of antinuclear antibodies (ANA), lupus syndrome, and Raynaud's phenomenon. POTENTIAL ADVERSE EFFECTS: In addition, a variety of adverse effects have been reported with other beta-adrenergic blocking agents, and may be considered potential adverse effects of TENORMIN. Hematologic: Agranulocytosis. Allergic: Fever, combined with aching and sore throat, laryngospasm, and respiratory distress. Central Nervous System: Reversible mental depression progressing to catatonia; tenormin withdrawal an acute reversible syndrome characterized by disorientation of time and place; short-term memory loss; emotional lability with slightly clouded sensorium; and, decreased performance on neuropsychometrics. Gastrointestinal: Mesenteric arterial thrombosis, ischemic colitis. Other: Erythematous rash. Miscellaneous: There have been reports of skin rashes and/or dry eyes associated with the use of beta-adrenergic blocking drugs. The reported incidence is small, and in most cases, the symptoms have cleared when tenormin withdrawal treatment was withdrawn. Discontinuance of the drug should be considered if any such reaction is not otherwise explicable. Patients should be closely monitored tenormin withdrawal following cessation of therapy. (See DOSAGE AND tenormin withdrawal ADMINISTRATION .) The oculomucocutaneous syndrome associated with the beta blocker practolol has not been reported with TENORMIN. Furthermore, a number of patients who had previously demonstrated established practolol reactions were transferred to TENORMIN therapy with subsequent resolution or quiescence of the tenormin withdrawal reaction. OVERDOSAGE Overdosage with TENORMIN has been reported with patients surviving acute doses as high as 5 tenormin withdrawal g. One death was reported in a man who tenormin withdrawal may have taken as much as 10 g acutely. The predominant symptoms tenormin withdrawal reported following TENORMIN overdose are lethargy, disorder of respiratory drive, wheezing, sinus pause tenormin withdrawal and tenormin withdrawal bradycardia. Additionally, common effects associated with overdosage of tenormin withdrawal any beta-adrenergic blocking agent and which might also be expected in TENORMIN overdose are congestive heart failure, hypotension, bronchospasm and/or hypoglycemia. Treatment of overdose should be directed to the removal of any unabsorbed drug by induced emesis, gastric lavage, or administration of activated charcoal. TENORMIN can be removed from the general circulation by hemodialysis. Other treatment modalities should be employed at tenormin withdrawal the physician's discretion and tenormin withdrawal may include: BRADYCARDIA: Atropine intravenously. If there is no response to vagal blockade, give isoproterenol cautiously. In refractory cases, a transvenous cardiac tenormin withdrawal pacemaker may be indicated. HEART BLOCK (SECOND OR THIRD DEGREE): Isoproterenol or transvenous cardiac pacemaker. CARDIAC FAILURE: Digitalize the patient and administer a diuretic. Glucagon has been reported to be useful. HYPOTENSION: Vasopressors such as dopamine or norepinephrine (levarterenol). Monitor blood pressure continuously. BRONCHOSPASM: A tenormin withdrawal beta 2 stimulant such as isoproterenol or terbutaline and/or aminophylline. HYPOGLYCEMIA: Intravenous glucose. Based on the severity of symptoms, management may require intensive support care tenormin withdrawal and facilities for applying cardiac and respiratory support. DOSAGE AND ADMINISTRATION Hypertension: The initial dose of TENORMIN is 50 mg given as one tablet a day either alone or added to diuretic therapy. The full effect of this dose will usually be seen within one to two weeks. If an optimal response is not achieved, the dosage should be increased to TENORMIN 100 mg given as one tablet a day. Increasing the dosage beyond 100 tenormin withdrawal mg a day is unlikely to produce any further benefit. TENORMIN may be used alone or concomitantly with other antihypertensive agents including thiazide type diuretics, hydralazine, prazosin, and alpha-methyldopa. Angina Pectoris: The initial dose of TENORMIN is 50 mg given as one tablet a day. If an optimal response is not achieved within one week, the dosage should be increased to TENORMIN 100 mg given as one tablet a day. Some patients may require a tenormin withdrawal dosage of 200 mg once a day for optimal effect. Twenty-four hour control with once daily dosing is achieved by giving doses larger than necessary to achieve an immediate maximum effect. The maximum early effect on exercise tolerance occurs with doses of 50 to 100 mg, but at these doses the effect at 24 hours is attenuated, averaging about 50% to 75% of that observed with once a day oral doses of 200 mg. Acute Myocardial Infarction: In patients with definite or suspected acute myocardial infarction, treatment with TENORMIN I.V. tenormin withdrawal Injection should be initiated as soon as possible after the patient's arrival in the hospital and after eligibility is established. Such treatment should be initiated in a coronary tenormin withdrawal care or similar unit immediately tenormin withdrawal after the patient's hemodynamic condition has stabilized. Treatment should begin with the intravenous administration of 5 mg TENORMIN over 5 minutes followed by another 5 mg intravenous injection 10 minutes later. TENORMIN I.V. Injection should be administered under carefully controlled conditions including monitoring of blood pressure, heart rate, and electrocardiogram. Dilutions of TENORMIN I.V. Injection in Dextrose Injection USP, Sodium Chloride Injection USP, or Sodium Chloride and Dextrose Injection may be used. These admixtures are stable for 48 hours if they are not tenormin withdrawal used immediately. In patients who tolerate the full intravenous dose (10 mg), TENORMIN Tablets 50 mg should be initiated 10 minutes after the last intravenous dose followed by another 50 mg oral dose 12 hours later. Thereafter, TENORMIN can be given orally either 100 mg once daily or 50 mg twice a day for a further 6-9 days or until discharge from the hospital. If bradycardia or hypotension requiring treatment or any other untoward effects occur, TENORMIN should be discontinued. (See full prescribing information prior to initiating therapy with TENORMIN Tablets.) Data from other beta blocker trials suggest that if there is any question concerning the use of IV beta blocker or clinical estimate that there is a contraindication, the IV beta blocker may be eliminated and patients fulfilling the safety criteria may be given TENORMIN Tablets 50 mg twice daily or 100 mg once a day for at least seven days (if the IV dosing is excluded). Although the demonstration of efficacy of TENORMIN is based entirely on data from the first seven postinfarction days, data from other beta blocker trials suggest that treatment with beta blockers that are effective in the postinfarction setting may be continued for one to three years if tenormin withdrawal there are no contraindications. TENORMIN is an additional treatment to standard coronary tenormin withdrawal care unit therapy. Elderly Patients or Patients with Renal Impairment: TENORMIN is excreted by the kidneys; consequently dosage should be adjusted in cases of severe impairment of renal function. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or tenormin withdrawal other drug therapy. Evaluation of patients with hypertension or myocardial infarction should always include assessment of renal tenormin withdrawal function. Atenolol excretion would be expected to decrease with advancing age. No significant accumulation of TENORMIN occurs until creatinine clearance falls below 35 mL/min/1.73m 2 . Accumulation of atenolol and prolongation of its half-life were studied tenormin withdrawal in subjects with creatinine clearance between 5 and 105 mL/min. Peak plasma levels were significantly increased in subjects with creatinine clearances below 30 mL/min. The following maximum oral dosages are recommended for elderly, renally-impaired tenormin withdrawal patients and for patients with renal impairment due to other causes: Creatinine Clearance (mL/min/1.73m 2 ) Atenolol Elimination Half-Life (h) Maximum Dosage 15-35 16-27 50 mg daily <15 >27 25 mg daily Some renally-impaired or elderly patients being treated for hypertension may require a lower starting dose of TENORMIN: 25 mg given as one tablet a day. If this 25 mg dose is used, assessment of efficacy must be made carefully. tenormin withdrawal This should include measurement of blood pressure just prior to the next dose ("trough" blood pressure) to ensure that the tenormin withdrawal treatment effect is present for a full 24 hours. Although a similar dosage reduction tenormin withdrawal may be considered for elderly and/or renally-impaired patients being treated for indications other than hypertension, data are not available for these patient populations. Patients on hemodialysis should be given 25 mg or 50 mg after each dialysis; this should be done under hospital supervision as marked falls in blood pressure can occur. Cessation of Therapy in Patients with Angina Pectoris: If withdrawal of TENORMIN therapy is planned, it should be achieved gradually and patients should be carefully observed and advised to limit physical activity to a minimum. HOW SUPPLIED TENORMIN Tablets: Tablets of 25 mg atenolol, NDC 0310-0107, (round, flat, uncoated tenormin withdrawal white tablets identified with "T" debossed on one side and 107 debossed tenormin withdrawal on the other side) are supplied in bottles of 100 tablets. Tablets of 50 mg atenolol, NDC 0310-0105, (round, flat, uncoated white tablets identified with "TENORMIN" debossed tenormin withdrawal on one side and 105 debossed on the other side, bisected) are supplied in bottles of 100 tablets. Tablets of 100 mg atenolol, NDC 0310-0101, (round, flat, uncoated white tablets identified with "TENORMIN" debossed on one side and 101 debossed tenormin withdrawal on the other side) are supplied in bottles of 100 tablets. Store at controlled room temperature, 20-25°C (68-77°F) [see USP]. Dispense in well-closed, light-resistant containers. All trademarks are the property of the AstraZeneca group © AstraZeneca 2002, 2003 Manufactured for: AstraZeneca Pharmaceuticals LP Wilmington, DE 19850 By: IPR Pharmaceuticals, Inc. Carolina, PR 00984 610200 Rev 04/03 AstraZeneca PRODUCT PHOTO(S): NOTE: These photos can be used only for identification by shape, color, and imprint. They do not depict actual or relative size. The product samples shown here have been supplied by the manufacturer and reproduced in full color by PDR as a quick-reference identification aid. While every effort has been made to tenormin withdrawal assure accurate reproduction, please remember that any visual identification should be considered preliminary. In cases of poisoning or suspected overdosage, the drug's identity should be verified by chemical analysis. Popular Searches Lipitor Viagra Cialis Levitra Zoloft Hair Transplant Health Insurance Healthy Diet Lose Weight Pain Relief Advertisement ADVERTISEMENT Home - Drug Interactions - Pill Identification - Question.com Advertisers - FAQs - Links - Privacy Policy - Terms of Use - Contact Us - Top Drugs - Merchandise tenormin withdrawal Store - About Drugs.comThe Drugs.com drug database is powered by MicromedexTM and MultumTM. Micromedex data last updated tenormin withdrawal 6 June 2005. Micromedex Physicians Desk Reference data last updated 18 May 2005.Multum data last updated 28 June 2005. © Copyright 2005 Drugs.com We subscribe to the HONcode principles. Verify here. |