Last update April 17, 2024

Atenolol

High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

A cardioselective beta-blocker β1 adrenergic used in the treatment of high blood pressure (HBP), angina pectoris, myocardial infarction, cardiac arrhythmias and in the prophylaxis of migraine. Oral administration once a day.

It is excreted in breastmilk in varying quantities but which could be clinically significant, being able to exceed 10% relative dose. (Lwin 2018, Eyal 2010, Hebert 2005, Schmimmel 1989, Atkinson 1988, Kulas 1984, Thorley 1983)

Varying levels have been measured in the plasma or urine of infants whose mothers were taking it (Lwin 2018, Schmimmel 1989, Fowler 1984, Thorley 1983, Liedholm 1982 and 1981), although some authors have not found detectable levels in the plasma or urine of infants. (Eyal 2010, Kulas 1984, White 1984)

In general, no problems have been observed in infants whose mothers were taking this medication (Eyal 2010, Kulas 1984, White 1984, Fowler 1984, Thorley 1983, Liedholm 1982), except for a newborn who, at 5 days of age, presented bradycardia, cyanosis and hypothermia; the mother was taking 50 mg/12 hours of atenolol for postpartum hypertension; the symptoms disappeared when the mother discontinued the medication (Schmimmel 1989). A case of drowsiness has been described in an infant whose mother was taking propranolol and other medications (Ho 1999) and a case of excessive weight loss at 17 days in a low-weight newborn whose mother was also taking mexiletine. (Lownes 1987)

Hyperprolactinemia and galactorrhea have been observed with the use of atenolol. (Lee 1982)

Within the same group, there are drugs with a safer pharmacokinetic profile for breastfeeding (higher protein binding, shorter half-life and lower oral bioavailability (Tamargo 2011, Riant 1986) and that are known not to cause problems during breastfeeding (Anderson 2018). Safer alternatives are preferred during breastfeeding, especially during the neonatal period and in case of prematurity. (Lwin 2018, Malachias 2016, Davanzo 2014, Hutchinson 2013, Rowe 2013, Ghanem 2008, Hale 2003, WHO 2002, Shannon 2000)

Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

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Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Atenolol in other languages or writings:

Tradenames

Main tradenames from several countries containing Atenolol in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 50 - 60 %
Molecular weight 266 daltons
Protein Binding 6 - 16 %
VD 1.3 l/Kg
pKa 14.1 -
Tmax 2 - 8 hours
6 - 9 hours
M/P ratio 1.5 - 8.6 -
Theoretical Dose 0.1 - 0.3 mg/Kg/d
Relative Dose 4.2 - 19 %
Ped.Relat.Dose 10 - 40 %

References

  1. Anderson PO. Treating Hypertension During Breastfeeding. Breastfeed Med. 2018 Abstract
  2. Lwin EMP, Gerber C, Leggett C, Song Y, Ritchie U, Turner S, Hague W, Upton R, Garg S. Estimation of Atenolol Transfer Into Milk and Infant Exposure During Its Use in Lactating Women. J Hum Lact. 2018 Abstract
  3. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016 Abstract Full text (link to original source)
  4. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  5. Hutchinson S, Marmura MJ, Calhoun A, Lucas S, Silberstein S, Peterlin BL. Use of common migraine treatments in breast-feeding women: a summary of recommendations. Headache. 2013 Abstract Full text (link to original source) Full text (in our servers)
  6. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  7. Tamargo Menéndez J, Delpón Mosquera E. Farmacología de los bloqueantes de los receptores β-adrenérgicos. Curso βeta 2011 de Actualización en Betabloqueantes. 2011 Full text (in our servers)
  8. Eyal S, Kim JD, Anderson GD, Buchanan ML, Brateng DA, Carr D, Woodrum DE, Easterling TR, Hebert MF. Atenolol pharmacokinetics and excretion in breast milk during the first 6 to 8 months postpartum. J Clin Pharmacol. 2010 Abstract Full text (in our servers)
  9. Ghanem FA, Movahed A. Use of antihypertensive drugs during pregnancy and lactation. Cardiovasc Ther. 2008 Abstract Full text (link to original source) Full text (in our servers)
  10. Hebert MF, Carr DB, Anderson GD, Blough D, Green GE, Brateng DA, Kantor E, Benedetti TJ, Easterling TR. Pharmacokinetics and pharmacodynamics of atenolol during pregnancy and postpartum. J Clin Pharmacol. 2005 Abstract
  11. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Abstract Full text (link to original source) Full text (in our servers)
  12. Ho T, Moretti M, Shaeffer I, Ito S, Koren G. Maternal β-Blocker Usage and Breast Feeding in the Neonate. Pediatr Res. 1999;45:67. Poster 385. Full text (link to original source) Full text (in our servers)
  13. Lee ST. Hyperprolactinemia, galactorrhea, and atenolol. Ann Intern Med. 1992 Abstract
  14. Schimmel MS, Eidelman AI, Wilschanski MA, Shaw D Jr, Ogilvie RJ, Koren G. Toxic effects of atenolol consumed during breast feeding. J Pediatr. 1989 Abstract
  15. Atkinson HC, Begg EJ, Darlow BA. Drugs in human milk. Clinical pharmacokinetic considerations. Clin Pharmacokinet. 1988 Abstract
  16. Lownes HE, Ives TJ. Mexiletine use in pregnancy and lactation. Am J Obstet Gynecol. 1987 Aug;157(2):446-7. Abstract
  17. Riant P, Urien S, Albengres E, Duche JC, Tillement JP. High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol. 1986 Abstract
  18. Fowler MB, Brudenell M, Jackson G, Holt DW. Essential hypertension and pregnancy: successful outcome with atenolol. Br J Clin Pract. 1984 Abstract
  19. Kulas J, Lunell NO, Rosing U, Stéen B, Rane A. Atenolol and metoprolol. A comparison of their excretion into human breast milk. Acta Obstet Gynecol Scand Suppl. 1984 Abstract
  20. White WB, Andreoli JW, Wong SH, Cohn RD. Atenolol in human plasma and breast milk. Obstet Gynecol. 1984 Abstract
  21. Thorley KJ, McAinsh J. Levels of the beta-blockers atenolol and propranolol in the breast milk of women treated for hypertension in pregnancy. Biopharm Drug Dispos. 1983 Abstract
  22. Liedholm H, Wåhlin-Boll E, Hanson A, Ingemarsson I, Melander A. Transplacental passage and breast milk concentrations of hydralazine. Eur J Clin Pharmacol. 1982 Abstract
  23. Liedholm H, Melander A, Bitzén PO, Helm G, Lönnerholm G, Mattiasson I, Nilsson B, Wåhlin-Boll E. Accumulation of atenolol and metoprolol in human breast milk. Eur J Clin Pharmacol. 1981 Abstract

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