Atenolol withdrawal effects
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Atenolol Withdrawal Effects: Overview and Key Findings
Atenolol, a beta-blocker, is commonly used for hypertension, angina, and other cardiovascular conditions. Understanding its withdrawal effects is important for patient safety and effective management.
Hormonal and Adrenergic Changes After Atenolol Withdrawal
Research shows that stopping atenolol can lead to hormonal changes indicating increased adrenergic (stress hormone) activity. Specifically, there are elevations in plasma cortisol, insulin, and glucose levels after withdrawal, suggesting the body experiences a rebound in stress-related hormones and blood sugar regulation . These changes are part of a broader withdrawal syndrome seen with beta-blockers, though the specific effects can differ depending on the drug’s properties .
Haemodynamic (Heart Rate and Blood Pressure) Responses
Withdrawal from atenolol can cause increased sensitivity to adrenergic stimulation, leading to a temporary overshoot in heart rate and, in some cases, blood pressure, especially during physical activity or physiological stress 410. Some individuals may experience more pronounced increases in heart rate and blood pressure than others, and these effects can last longer than previously thought 410. However, in patients with stable angina, abrupt withdrawal of atenolol generally results in only minor clinical consequences, with no significant increase in serious coronary events or arrhythmias observed in the short term .
Blood Pressure Control and Antihypertensive Therapy
In patients on combination antihypertensive therapy, removing atenolol can lead to a rise in blood pressure and a loss of blood pressure control, especially when used alongside other medications like ACE inhibitors or calcium channel blockers . The proportion of patients with well-controlled blood pressure drops significantly after atenolol withdrawal, highlighting its important role in multi-drug regimens .
Neuromuscular Effects: Tremor
Withdrawal of atenolol after long-term use can cause a mild increase in postural tremor, but this effect is less pronounced than with some other beta-blockers like propranolol . The increase in tremor is generally limited to specific positions and frequency ranges, and is not usually severe .
Atenolol in Alcohol and Benzodiazepine Withdrawal
Atenolol has been studied as an aid in managing alcohol withdrawal syndrome. It has been shown to help normalize vital signs and reduce withdrawal symptoms more quickly than placebo, both in outpatient and inpatient settings 57. Patients treated with atenolol also required less additional medication and had shorter hospital stays . However, when used for benzodiazepine withdrawal, atenolol did not show significant benefits over placebo in reducing withdrawal symptoms .
Individual Variability and Duration of Withdrawal Effects
There is considerable individual variability in the severity and duration of withdrawal effects. Some people may experience more pronounced symptoms, and the time course of these effects can vary widely, sometimes lasting several days after stopping the drug 410.
Conclusion
Atenolol withdrawal can lead to hormonal and cardiovascular changes, including increased heart rate, blood pressure, and stress hormone levels. While most effects are mild and manageable, especially in stable patients, careful monitoring is recommended, particularly in those with cardiovascular disease or on complex antihypertensive regimens. Atenolol may also be beneficial in managing alcohol withdrawal, but not benzodiazepine withdrawal. Individual responses to withdrawal can vary, so personalized care is important.
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