Norpress 50 mg is indicated for:

• Management of hypertension, either as monotherapy or in combination with other antihypertensive agents, especially thiazide-type diuretics.
• Long-term treatment of angina pectoris.
• Management of hemodynamically stable patients with confirmed or suspected acute myocardial infarction to reduce cardiovascular mortality.

Atenolol is a β1-selective (cardioselective) β-adrenergic receptor blocker developed to selectively inhibit cardiac β1 receptors without significantly affecting β2 receptors. It does not possess membrane-stabilizing or intrinsic sympathomimetic activity. Atenolol is relatively hydrophilic compared to other beta-blockers, resulting in limited penetration across lipid membranes. This contributes to its selective action and reduced central nervous system effects.

Hypertension: The initial dose of Atenolol is 50 mg given as one tablet a day either alone or added to diuretic therapy. The full effect of this dose will usually be seen within one to two weeks. If an optimal response is not achieved, the dosage should be increased to Atenolol 100 mg given as one tablet a day. Increasing the dosage beyond 100 mg a day is unlikely to produce any further benefit.

Angina Pectoris: The initial dose of Atenolol is 50 mg given as one tablet a day. If an optimal response is not achieved within one week, the dosage should be increased to Atenolol 100 mg given as one tablet a day. Some patients may require a dosage of 200 mg once a day for optimal effect. Twenty-four hour control with once daily dosing is achieved by giving doses larger than necessary to achieve an immediate maximum effect. The maximum early effect on exercise tolerance occurs with doses of 50 to 100 mg, but at these doses the effect at 24 hours is attenuated, averaging about 50% to 75% of that observed with once a day oral doses of 200 mg.

Acute Myocardial Infarction: In patients with definite or suspected acute myocardial infarction, treatment with Atenolol I.V. Injection should be initiated as soon as possible after the patient's arrival in the hospital and after eligibility is established. Treatment should begin with the intravenous administration of 5 mg Atenolol over 5 minutes followed by another 5 mg intravenous injection 10 minutes later. In patients who tolerate the full intravenous dose (10 mg), Atenolol Tablets 50 mg should be initiated 10 minutes after the last intravenous dose followed by another 50 mg oral dose 12 hours later. Thereafter, Atenolol can be given orally either 100 mg once daily or 50 mg twice a day for a further 6-9 days or until discharge from the hospital. If bradycardia or hypotension requiring treatment or any other untoward effects occur, Atenolol should be discontinued

Atenolol is contraindicated in patients with sinus bradycardia, greater than first-degree heart block, cardiogenic shock, or overt cardiac failure, as well as in individuals with known hypersensitivity to atenolol or any component of the formulation.

Bradycardia and hypotension are commonly observed, particularly in patients treated after acute myocardial infarction. Other reported adverse effects include:

• Hematologic: Agranulocytosis.
• Allergic: Fever with sore throat, laryngospasm, and respiratory distress.
• Central nervous system: Reversible depression, confusion, memory impairment, emotional instability, and decreased cognitive performance.
• Gastrointestinal: Mesenteric arterial thrombosis and ischemic colitis.
• Miscellaneous: Skin rash, dry eyes; discontinuation may be required if such reactions occur. Patients should be monitored after stopping therapy.
• Other: Erythematous rash.

Atenolol is classified as Pregnancy Category D. It should be used with caution during breastfeeding, as clinically significant bradycardia has been reported in breastfed infants. Premature infants or those with impaired renal function may be at higher risk of adverse effects.

General: Patients already receiving beta-blockers should be carefully evaluated before initiating atenolol. Dosage should be adjusted based on clinical response, including pulse rate and blood pressure. Atenolol may worsen peripheral arterial circulation disorders.

Impaired Renal Function: Use cautiously in patients with renal impairment.

Geriatric Use:

• In elderly patients with hypertension or angina, dose selection should be cautious and usually initiated at the lower end of the dosing range due to reduced hepatic, renal, or cardiac function and possible comorbidities.
• In acute myocardial infarction, similar caution is required, and renal function should always be assessed.

In elderly patients and those with renal impairment, atenolol dosage should be adjusted as it is primarily excreted by the kidneys. Dose selection should begin at the lower end of the range. Recommended maximum oral doses:

• Creatinine clearance 15–35 mL/min/1.73 m²: Maximum 50 mg daily.
• Creatinine clearance <15 mL/min/1.73 m²: Maximum 25 mg daily.

Some elderly or renally impaired patients with hypertension may require a lower starting dose of 25 mg once daily. Patients undergoing hemodialysis should receive 25 mg or 50 mg after each dialysis session under close supervision due to risk of significant hypotension.

Overdose of atenolol has been reported at doses up to 5 g, with survival in most cases; however, fatal cases have occurred at higher doses. Symptoms may include lethargy, respiratory depression, wheezing, sinus pause, and marked bradycardia. Other possible effects include congestive heart failure, hypotension, bronchospasm, and hypoglycemia. Management includes supportive care, removal of unabsorbed drug by gastric lavage or activated charcoal, and hemodialysis if necessary. Intensive monitoring and cardiac/respiratory support may be required.

Beta-adrenoceptor blocking agent (beta-blocker).

Do not use after the expiry date. Keep all medicines out of the reach of children. To be dispensed only on the prescription of a registered physician.