Problems with Atenolol

Q. My father takes atenolol to control his blood pressure. He has had terrible difficulties with respiration in addition to low-grade depression and lack of energy. Is there an alternative class of drugs that he could try? He is by nature a very active, energetic man and feels virtually immobilized by this drug, so he’s very anxious to seek out better options.

A. Although beta blockers like atenolol, metoprolol or propranolol are frequently prescribed, such drugs are rarely appropriate as first-line blood pressure medications (Cochrane Database of Systematic Reviews, Aug. 15, 2012).

They may not reduce the likelihood of heart attacks or strokes (Archives of Internal Medicine, Oct. 8, 2012).

Beta blockers can make breathing more difficult, especially for people susceptible to asthma (Journal of Asthma, Nov., 2012). Fatigue and depression are also potential side effects.

We discuss the pros and cons of beta blockers plus various other blood pressure medicines and non-drug approaches in our book, Best Choices From The People’s Pharmacy (online at PeoplesPharmacy.com). Your father must not discontinue atenolol without medical supervision.

Other readers have also had some problems with atenolol. Here is one story: “I had been feeling tired and had no energy for years. My feet and ankles would swell to twice the size. I started to have shortness of breath. My cardiologist ran every test and everything showed normal. She was ready to give up and then decided to try one last thing.

She cut my atenolol to half the amount I was taking. In two days I had all kinds of energy, no shortness of breath or swelling. I feel at least ten years younger than my 73 years. Atenolol slows the heart rate down. I have lost 15 pounds because I am so much more active now.”

Another person, like your father, found that the drug precipitate breathing difficulty: “I was on a low dose of atenolol for about a year. It left me with chronic asthma/low-grade bronchitis.”

Finally, though we worry most about cardiac reactions to stopping atenolol suddenly, here is another reader’s experience suggesting that abrupt discontinuation may be quite uncomfortable as well as risky: “My brother’s doctor added atenolol 50 mg to his Lisinopril-HCTZ (40-25 mg) medications after 3 months to get his blood pressure down to below 120/80. It worked (bp about 100/70) but his heart rate had been in the 60s and ended up at times in the 40s with the atenolol 50 mg. While on the atenolol for 4 months, he was able to sleep but not great. While the doctor prescribed taking the atenolol all at once, we found he seemed to feel a little better with the dose split 50-50 morning-night.

At his last doctor visit, the doctor lowered the atenolol dose to 25mg to be taken at night due to a pulse in the 40s and my statement that my brother seemed a little slower moving. After 10 days on the reduced dose, my brother developed complete insomnia (no sleep at all for 6 nights straight). We called the doctor and the nurse added trazodone 50 mg. He took that for 3 nights and it did nothing. When we called the nurse, she said trazodone takes time to work.

After reading about atenolol withdrawal and the risks of trazodone, we decided that he should go back to his prior atenolol dose of 50mg split morning and night and not take the trazodone. He did get a decent night’s sleep the 2nd night of going back on 50 mg atenolol but it didn’t seem to help the first and third night. We are hoping it works tonight.”