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Tenormin IV Injection

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Tenormin I.V. Injection

Discontinued Warning IconPlease Note: This Brand Name drug is no longer available in the US.
(Generic versions may still be available.)

Side Effects
Interactions

SIDE EFFECTS

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 either volunteered by the patient (US studies) or elicited, eg, by checklist (foreign studies). The reported frequency of elicited adverse effects was higher for both TENORMIN and 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)
(n=164)
%
Placebo
(n=206)
%
Atenolol
(n=399)
%
Placebo
(n=407)
%
3
0
3
0
Cold Extremities
0
0.5
12
5
2
1
4
5
0
0.5
3
1
CENTRAL NERVOUS SYSTEM/ NEUROMUSCULAR
Dizziness
4
1
13
6
2
0.5
2
0.2
Light-headedness
1
0
3
0.7
0.6
0.5
26
13
3
1
6
5
1
0
3
0.7
Drowsiness
0.6
0
2
0.5
0.6
0.5
12
9
Dreaming
0
0
3
1
2
0
3
2
4
1
3
1
Wheeziness
0
0
3
3
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 atenololtreated patients than in control patients. However, these usually responded to atropine and/or to withholding further dosage of atenolol. The incidence 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
(1.20%)
2
(0.90%)
Heart Failure
46
(19%)
56
(24%)
11
(4.50%)
10
(4.30%)
BBB + Major Axis Deviation
16
(6.60%)
28
(12%)
28
(11.50%)
45
(19%)
12
(5%)
29
(11%)
4
(1.60%)
7
(3%)
39
(16%)
52
(22%)
Cardiac Reinfarction
0
(0%)
6
(2.60%)
Total Cardiac Arrests
4
(1.60%)
16
(6.90%)
Nonfatal Cardiac Arrests
4
(1.60%)
12
(5.10%)
Deaths
7
(2.90%)
16
(6.90%)
Cardiogenic Shock
1
(0.40%)
4
(1.70%)
Development of Ventricular
Septal Defect
0
(0%)
2
(0.90%)
Development of Mitral
0
(0%)
2
(0.90%)
Renal Failure
1
(0.40%)
0
(0%)
3
(1.20%)
0
(0%)

In the subsequent International Study of Infarct Survival (ISIS-1) including over 16,000 patients of whom 8,037 were 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
(1.30%)
1168
(14.50%)
Cardiogenic Shock
4
(0.04%)
35
(0.44%)
Reinfarction
0
(0%)
5
(0.06%)
5
(0.06%)
28
(0.34%)
Heart Block (>first degree)
5
(0.06%)
143
(1.70%)
Cardiac Failure
1
(0.01%)
233
(2.90%)
Arrhythmias
3
(0.04%)
22
(0.27%)
Bronchospasm
1
(0.01%)
50
(0.62%)

*Full dosage was 10 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 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 Raynauds 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; 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 treatment was withdrawn. Discontinuance of the drug should be considered if any such reaction is not otherwise explicable. Patients should be closely monitored following cessation of therapy. (See DOSAGE AND 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 reaction.

Read the Tenormin I.V. Injection (atenolol inj) Side Effects Center for a complete guide to possible side effects

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 evidence of hypotension and/or marked bradycardia which may produce vertigo, 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 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, eg, indomethacin, may decrease the hypotensive effects of beta blockers.

Caution should be exercised with TENORMIN I.V. Injection (atenolol inj) when given in close proximity with drugs that may also have a depressant effect on myocardial contractility. On rare occasions, concomitant use of intravenous beta blockers and intravenous verapamil has resulted in serious adverse reactions, especially in patients with severe cardiomyopathy, congestive heart failure, or recent myocardial infarction.

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 to a variety of allergens may have a more severe reaction on repeated challenge, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.

Read the Tenormin I.V. Injection Drug Interactions Center for a complete guide to possible interactions

Last reviewed on RxList: 9/10/2005
This monograph has been modified to include the generic and brand name in many instances.

Side Effects
Interactions
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