Atenolol withdrawal
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Atenolol Withdrawal: Clinical Implications and Observations
Introduction to Atenolol Withdrawal
Atenolol, a beta-adrenoceptor blocking drug, is commonly used for managing hypertension, angina, and alcohol withdrawal syndrome. However, the cessation of atenolol therapy can lead to withdrawal phenomena, which vary in severity and manifestation. This article synthesizes findings from multiple studies to provide a comprehensive overview of the clinical implications of atenolol withdrawal.
Hormonal and Hemodynamic Changes Post-Atenolol Withdrawal
Hormonal Evidence of Adrenergic Overactivity
Withdrawal from atenolol has been associated with significant hormonal changes indicative of adrenergic overactivity. Studies have shown elevations in plasma cortisol, insulin, and glucose levels following the cessation of atenolol 2. These hormonal shifts suggest a rebound effect, where the body exhibits increased adrenergic activity once the beta-blockade is removed.
Hemodynamic Responses and Sensitivity
The withdrawal of atenolol also results in notable hemodynamic changes. Research indicates that there is a hypersensitivity to isoprenaline, leading to an overshoot in heart rate (HR) and blood pressure (BP) responses during physiological maneuvers 6. This hypersensitivity can persist longer than previously realized, highlighting the need for careful monitoring during the withdrawal period.
Clinical Outcomes in Hypertensive and Angina Patients
Gradual Return to Baseline in Hypertensive Patients
In hypertensive patients, the cessation of long-term atenolol therapy results in a gradual return of BP and HR to baseline values. This process exceeds the time required for the drug's elimination, indicating a prolonged offset of effect 3. Despite these changes, there is no significant evidence of increased cardiac adrenergic sensitivity or rebound hypertension, contrasting with the withdrawal syndrome observed with propranolol 3.
Minor Clinical Consequences in Angina Patients
For patients with severe stable angina, abrupt withdrawal of atenolol has been shown to result in minor clinical consequences. Studies report a steady rise in mean and maximal daily heart rates post-withdrawal, but no serious coronary events or significant arrhythmias were observed 7. This suggests that while there are physiological changes, the clinical impact may be less severe compared to other beta-blockers.
Alcohol Withdrawal Syndrome and Atenolol
Improved Outcomes in Alcohol Withdrawal
Atenolol has been found to be beneficial in managing alcohol withdrawal syndrome. Clinical trials indicate that patients receiving atenolol experience a more rapid normalization of vital signs and resolution of abnormal behaviors compared to those receiving a placebo 14. Additionally, the need for concomitant benzodiazepines is reduced in patients treated with atenolol, further supporting its efficacy in this context 1.
Reduced Craving and Treatment Failure
In outpatient settings, atenolol has been shown to reduce levels of alcohol craving and treatment failure rates. Patients receiving atenolol reported lower levels of craving and had better overall treatment outcomes compared to those on placebo 45. This suggests that atenolol not only aids in the acute management of withdrawal symptoms but also supports long-term abstinence and relapse prevention.
Conclusion
The withdrawal of atenolol can lead to significant hormonal and hemodynamic changes, with varying clinical implications depending on the patient population. While hypertensive and angina patients may experience a gradual return to baseline physiological states, those undergoing alcohol withdrawal benefit from improved outcomes and reduced craving. These findings underscore the importance of careful management and monitoring during the withdrawal period to mitigate potential adverse effects.
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Most relevant research papers on this topic
Randomized clinical trial of atenolol in patients with alcohol withdrawal.
Atenolol effectively reduces hospital stay duration and benzodiazepine use in patients with alcohol withdrawal syndrome, improving vital signs and reducing benzodiazepine use.
RCT
Highly CitedWithdrawal phenomena after atenolol and bopindolol: hormonal changes in normal volunteers.
The withdrawal syndrome after beta-adrenoceptor blockade drugs differs between atenolol and bopindolol, with atenolol showing adrenergic overactivity and bopindolol showing prolactin overshoot and persistent elevation
Non-RCTWithdrawal of long-term therapy with atenolol in hypertensive patients.
Long-term atenolol therapy in hypertensive patients leads to gradual return to baseline blood pressure and heart rate levels without rebound hypertension or increased cardiac adrenergic sensitivity.
Non-RCTThe efficacy of atenolol in the outpatient management of the alcohol withdrawal syndrome. Results of a randomized clinical trial.
Atenolol improves outpatient management and treatment outcomes of alcohol withdrawal syndrome, with reduced craving levels.
RCTHighly CitedRandomized controlled trial in alcohol relapse prevention: role of atenolol, alcohol craving, and treatment adherence.
Daily use of atenolol in abstinent alcoholics can reduce relapse rates by 28%, but treatment adherence remains crucial for long-term success.
RCTWithdrawal phenomena after atenolol and bopindolol: haemodynamic responses in healthy volunteers.
Both atenolol and bopindolol cause withdrawal phenomena in healthy volunteers, with some individuals more prone to experiencing these effects.
Non-RCTAbrupt withdrawal of atenolol in patients with severe angina. Comparison with the effects of treatment.
Abrupt withdrawal of atenolol in patients with severe stable angina resulted in minor clinical consequences, with rebound events related to both the clinical setting and the agent used.
Non-RCTChanges in blood pressure, heart rate and thyroid hormones after sudden withdrawal of pindolol and atenolol in hypertensive patients.
Abrupt withdrawal of pindolol and atenolol in hypertensive patients leads to minor thyroid hormone changes and a slight overshoot in heart rate, with no correlation between free-T3 alterations and cardiovascular parameters.
RCTAbrupt withdrawal of atenolol in patients with severe angina: comparison with the effects of treatment.
Atenolol withdrawal may carry a risk of coronary event in patients with little or no angina, and it is crucial to withdraw beta blockers gradually, regardless of the disease under treatment.
Effect on finger tremor of withdrawal of long-term treatment with propranolol or atenolol.
Long-term treatment with propranolol or atenolol can increase finger tremor, while atenolol may cause a narrower increase in tremor in the postural position.
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