Adverse effects of atenolol

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Adverse Effects of Atenolol

Atenolol, a beta-blocker commonly prescribed for hypertension and other cardiovascular conditions, has been associated with a range of adverse effects. This article synthesizes findings from multiple studies to provide a comprehensive overview of these adverse effects.

Dermatological Adverse Effects

Psoriasiform Skin Eruptions and Skin Necrosis

Atenolol can induce various dermatological side effects, including psoriasiform skin eruptions and skin necrosis. These conditions are characterized by scaly, red patches on the skin, which can be severe and require discontinuation of the drug.

Pityriasis Rosea-like Reactions

A rare but documented adverse effect of atenolol is a pityriasis rosea-like reaction. This condition presents as diffuse, bright red to violet scaly patches on the trunk and extremities. The diagnosis is typically confirmed through dermatological examination and histopathological findings.

Drug-induced Lupus Erythematosus

Atenolol has also been linked to drug-induced lupus erythematosus, a condition where the immune system attacks the body's own tissues. This was confirmed in a patient who developed lupus symptoms and antihistone antibodies while on atenolol, which subsided after discontinuation of the drug.

Gastrointestinal and Systemic Adverse Effects

Gastrointestinal Symptoms

In a systematic review of atenolol for treating infantile hemangioma, gastrointestinal symptoms such as constipation, diarrhea, and vomiting were the most frequently reported adverse events, affecting approximately 22.6% of patients.

Hypotension and Bradycardia

Atenolol can cause hypotension (low blood pressure) and bradycardia (slow heart rate), particularly in patients with chronic kidney disease (CKD). This is due to the drug's renal elimination, which can lead to higher systemic exposure in these patients.

Central Nervous System Adverse Effects

Acute Psychotic Behavior

Although atenolol is less likely to cross the blood-brain barrier compared to other beta-blockers, there have been reports of acute psychotic behavior, including vivid dreams, nightmares, and memory lapses. In one case, a patient exhibited violent behavior and confusion, which subsided after discontinuation of the drug.

Fatigue and Sleep Disturbances

Common central nervous system side effects include fatigue, headaches, sleep disturbances, and difficulty concentrating. These effects are generally mild but can lead to discontinuation of the medication in some cases.

Cardiovascular Adverse Effects

Bradycardia and Hypotension in Children

In pediatric patients treated for ventricular arrhythmias, atenolol has been associated with bradycardia and hypotension. These cardiovascular side effects necessitate careful monitoring and dosage adjustments.

Platelet Adhesion and Aggregation

Atenolol has been shown to reduce platelet adhesion in hypertensive patients, which may contribute to its cardioprotective effects. However, it has little effect on platelet aggregation, and its impact on blood chemistry and hematological parameters is minimal.

Conclusion

Atenolol is an effective beta-blocker for managing hypertension and other cardiovascular conditions, but it is associated with a range of adverse effects. These include dermatological reactions, gastrointestinal symptoms, central nervous system disturbances, and cardiovascular issues. Clinicians should carefully monitor patients on atenolol, especially those with pre-existing conditions like CKD, to mitigate these adverse effects.