Stadnolol 50

Rx

Indications

• Management of high blood pressure.
• Management of supraventricular arrhythmias.
• Management of ventricular arrhythmias.

Dosage

• High blood pressure
  The recommended dosage is 100 mg once a day (i.e. 2 tablets of 50 mg), preferably in the morning.
• Rhythm disturbances
  After controlled arrhythmias with intravenous atenolol (if indicated), atenolol should be administered orally and the recommended maintenance dose is 50 – 100 mg/day.
• Renal insufficiency
  The dosage is adjusted to the values of serum creatinine or creatinine clearance:
  CC 15 – 35 ml/minute per 1.73 m²: A maximum dosage of 50 mg daily is recommended.
  CC less than 15 ml/minute per 1.73 m²: 25 mg daily or 50 mg every other day.

Usage

Stadnolol 50 is administered orally before meals.

• Metabolic acidosis.
• Hypotension.
• Severe peripheral arterial circulatory disturbances.
• Severe asthma.
• Severe chronic obstructive pulmonary disorders.
• Untreated phaeochromocytoma.
• Patients with sinus bradycardia (< 50 bpm before treatment initiation), AV block greater than first degree and overt or decompensated cardiac failure.
• Concomitant therapy with verapamil.
• Heart failure not controlled by treatment.
• Cardiogenic shock.
• AV block of second and third degree not matched.
• Prinzmetal’s angina (in combination with other drugs or monotherapy).
• Sinus syndrome (including sinoatrial block).
• Bradycardia (< 45 – 50 bpm).
• Raynaud’s phenomenon and peripheral arterial disease in their severe forms.
• Hypersensitivity with atenolol or to any of the excipients, history of anaphylactic reaction.
• Breastfeeding.
• Children.

Common

• Bradycardia.
• Cold extremities.
• Gastrointestinal disturbances.
• Fatigue.

Warnings

• Never stop treatment abruptly in angina patients: Abrupt stopping can lead to serious arrhythmias, a myocardial infarction or sudden death.
• It is not recommended to take this medicine with diltiazem, verapamil, fingolimod and ozanimod.

Precautions

• Treatment should not be stopped suddenly, especially in patients with ischemic heart disease. The dose should be reduced gradually, ideally over 1 – 2 weeks, starting at the same time with the replacement therapy, if necessary, to avoid worsening of angina.
• Asthma and chronic obstructive pulmonary disease: Beta-blockers can only be administered in mild forms by choosing a selective beta-1 at a low starting dose. It is recommended that functional respiratory tests be performed before starting treatment.
• In patients with heart failure controlled by treatment and if necessary, atenolol will be administered in very low, gradually increasing doses and under strict medical supervision.
• Bradycardia: If the rate drops below 50 – 55 bpm at rest and the patient exhibits symptoms related to bradycardia, the dosage should be reduced.
• Due to their negative dromotropic effect, beta-blockers should be administered with caution to patients with first degree atrioventricular block.
• Beta-blockers can increase the number and duration of attacks in patients with Prinzmetal’s angina. The use of a cardioselective beta-blocker is possible, in minor and associated forms, provided that a vasodilator is administered jointly.
• In patients with peripheral arterial disorders (Raynaud’s disease or syndrome, arteritis or chronic obliterating arterial disease of the lower limbs), beta-blockers may worsen these disorders. In these situations, a cardioselective beta-blocker with partial agonist power should be preferred, which should be administered with caution.
• The use of beta-blockers in the treatment of hypertension due to the pheochromocytoma being treated requires close monitoring of blood pressure.
• In the elderly, absolute compliance with the contraindications is imperative. Care should be taken to initiate treatment with a low dose and to ensure close monitoring.
• In the event of renal insufficiency, the dosage should be adjusted according to the state of renal function: In practice, it is sufficient to monitor the heart rate, so as to reduce the doses if excessive bradycardia appears (< 50 – 55 bpm at rest).
• Diabetic: Warn the patient and reinforce blood glucose self-monitoring at the start of treatment. The warning signs of hypoglycemia may be masked, in particular tachycardia, palpitations and sweating.
• Psoriasis: Worsening of the disease having been reported on beta-blockers, the indication deserves to be weighed.
• Allergic reactions: In patients at risk of having a severe anaphylactic reaction, regardless of the origin, especially with iodinated contrast media or during desensitizing therapy, beta-blocker therapy may lead to worsening of the reaction and resistance to its treatment with adrenaline at the usual dosages.
• General anaesthesia: Beta blockers will reduce reflex tachycardia and increase the risk of hypotension. Continuation of beta-blocker therapy decreases the risk of arrhythmia, myocardial ischemia and hypertensive flare-ups. The anesthetist should be advised that the patient is being treated with a beta blocker.
  –  If stopping treatment is deemed necessary, a suspension of 48 hours is considered sufficient to allow the reappearance of sensitivity to catecholamines.
  – In some cases the beta-blocker treatment can not be interrupted:
  • In patients with coronary insufficiency, it is advisable to continue treatment until surgery, given the risk associated with suddenly stopping beta-blockers.
  • In the event of an emergency or the impossibility of stopping, the patient must be protected from a predominantly vagus by sufficient premedication of atropine renewed as needed. The anesthesia should use products as little myocardial depressant as possible and blood loss should be compensated.
  – The anaphylactic risk should be taken into account.
• Thyrotoxicosis: Beta-blockers may mask the cardiovascular signs.
• Stadnolol 50 contains lactose. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.
• Administration of atenolol to pregnant women in the management of mild to moderate hypertension has been associated with intra-uterine growth retardation. The use of atenolol in women who are, or may become, pregnant requires that the anticipated benefit be weighed against the possible risks, particularly in the first and second trimesters.
• Atenolol is not recommended in nursing mothers.
• Patients using this medicine must receive regular medical monitoring. Individually different reactions may alter alertness to such an extent as to impair the ability to actively participate in road traffic, operate machines, or work without a firm support. This applies especially at the start of therapy, when increasing the dose or switching medications, or when using alcohol at the same time.