How long atenolol withdrawal

Patients often ask if any of their pills can be stopped. Consider involving the practice nurse and pharmacist for a team approach.

Check that there is still a valid clinical indication and ongoing clinical benefit for each medicine. It may be necessary to review the patient notes to check what the original indication was. Consider if the benefit of the drug has already been achieved or if the clinical condition of the patient has changed.

Check that the medicine is appropriate for use in an older person see below. These tools should not be used as a substitute for careful clinical judgement.

Consider if there are any other solutions that may be effective e. Prescribing for older people can be difficult. When considering any new medicine for an older person, check if it is appropriate by considering the following questions: Adapted from Holmes, 2. Check how long the patient has been on the medicine. Some medicines are repeated for years as it can be quicker and simpler to maintain the status quo.

Check if there was a clear understanding at the time of initiation about the expected duration of use, particularly if the medicine was started in a secondary care setting. For example, a patient who was initiated on dipyridamole after a TIA, who has had no further ischaemic events, may be able to stop this medicine after two years.

Check whether there is still an indication for the use of the medicine and if so, that its use is still consistent with recommendations in current guidelines. Consider if there are more up-to-date drugs on the market that may be superior and safer. Check if the patient is taking all of their prescribed medicines. If not, ask them why? Did they understand the aims of treatment and did they experience any adverse effects? If the patient has remained well without the medicine, and is unlikely to suffer harm if it is not taken, consider stopping it e.

When a patient presents with new symptoms, consider an adverse medicine reaction as a possible cause. The aim is to avoid the prescribing cascade where additional medicines are initiated to treat adverse effects both recognised and unrecognised of other medicines.

For some classes of medicine e. Recognise the need to stop a medicine When the patient presents for a renewal of medicine ask if they have any new symptoms including adverse effects or any concerns about their medicine. Has the clinical condition of the patient changed?

Consider the preferences of the patient. Are there drugs that can be stopped? If more than one medicine can be stopped, which one should be stopped first? This relies on clinical judgement and consideration of factors such as medicines most likely to cause adverse effects or without clear indications. Reduce or stop one medicine at a time Try to reduce or stop only one medicine at one time. If problems develop it is then easier to know what the likely cause may be.

Taper medicines when appropriate To reduce the likelihood of an adverse withdrawal event, many medicines should be tapered. It can be difficult to determine which can just be stopped and which should be tapered. Therefore if in doubt taper, as it is safer. For many medicines the first step in tapering is to halve the dose. Generally there will be plenty of time to taper a medicine. If the medicine is being discontinued because toxicity is a concern, then a more ambitious taper can be undertaken or the medicine stopped abruptly.

Once tapering has begun, ask the patient to note any symptoms that may suggest a more gradual withdrawal is required e.

If intolerable symptoms occur following a decrease in the dose or after the medicine has been stopped, then it may be necessary to restart the previously prescribed dose and then try tapering again, but at a more gradual rate. Check for benefit or harm after each medicine has been stopped Ask the patient if any changes have occurred after a medicine has been stopped.

Beneficial effects should be noted to reinforce that the decision to reduce or stop the medicine was correct. There is also evidence that the beneficial effects of some medicines may persist even after the medicine is stopped e. If symptoms of the initial condition return and are troublesome, despite gradual tapering, then it may be that the medicine cannot be stopped completely. The patient may however be able to be managed on a reduced dose e. Antidepressants should be tapered rather than stopped abruptly, to reduce the risk of developing a discontinuation syndrome and to allow time to assess the possible re-emergence of depressive symptoms Table 1.

Antidepressant discontinuation syndrome is more likely with a longer duration of treatment and a shorter half-life of the treatment drug. Antidepressants should normally be withdrawn over at least a four week period. Patients may experience withdrawal symptoms but usually these are mild and self-limiting.

If these symptoms are not tolerated, it may be necessary to resume the previous dose and then reduce the antidepressant more slowly. Regular and prolonged use of hypnotics should be avoided because of the risk of tolerance to effects, dependence and an increased risk of adverse events.

Patients who have taken benzodiazepines on a long term basis should be withdrawn gradually over a number of months e. The longer a patient has been taking a benzodiazepine, the more likely they are to develop dependence and tolerance.

There are a wide range of withdrawal symptoms Table 2 and some may be similar to those for which the benzodiazepine was originally prescribed.

Some patients may experience withdrawal symptoms such as rebound insomnia and anxiety after only two to four weeks of treatment. Withdrawal symptoms can continue for weeks or months after stopping a benzodiazepine.

Abrupt withdrawal may result in confusion, toxic psychosis, seizures or a condition termed benzodiazepine withdrawal syndrome which is similar to delirium tremens. Benzodiazepine withdrawal syndrome can occur within one day of stopping a short-acting benzodiazepine or up to three weeks after stopping a long-acting benzodiazepine. Successful discontinuation may result in improvements in cognitive and psychomotor function, particularly in older people.

Patients may be more alert and have increased working memory, reaction times and balance. Beta-blockers are the cardiovascular medicine most often associated with adverse withdrawal events. Abrupt withdrawal may cause rebound hypertension, tachycardia, arrhythmia or angina. These events may be physiological withdrawal reactions or an exacerbation of the underlying condition. The decision to stop a statin is based on an assessment of individual benefits and risks. For example, stopping may be justified in a person at relatively low risk of a cardiovascular event, who is also poorly compliant or experiencing troublesome adverse effects.

In most cases statins can be stopped without the need for tapering. Statins should not be stopped in patients admitted with or with a history of cardiovascular events including acute coronary syndrome, myocardial infarction and stroke. In older people taking warfarin, low initial and maintenance dosages are recommended e.

Some clinicians tail off long-term treatment over several weeks but the need for this is unclear. It is possible to stop abruptly rather than taper Table 4. Risks associated with NSAIDs usually relate to declining renal function in the older age group and adverse gastrointestinal effects.

NSAIDs may also reduce the effectiveness of antihypertensive therapy. Some patients may tolerate abrupt discontinuation but tapering the dose allows for other analgesics to be introduced or increased Table 5. Many people remain on acid suppressants despite there being no ongoing clinical indication e.

It is often possible to maintain symptom control on a lower dose or on an as needed basis rather than on long term high dose maintenance therapy. Tapering the dose of an acid suppressant both PPIs and H 2 RAs is recommended because of the risk of rebound hypersecretion of gastric acid Table 6. Following discontinuance of omeprazole therapy, gastric acid secretion returns to baseline over a three to five day period.

The beneficial effects e. Beneficial effects on BMD persist after stopping the drug. For correspondence regarding stopping alendronate therapy, see "Correspondence: Guidance for stopping alendronate" , BPJ 46 September, Tapering may not be required for some patients who have received low to moderate doses e. Withdrawal should not be abrupt for the majority of patients who have been taking systemic corticosteroids for more than three weeks.

These patients should generally have their corticosteroid slowly tapered to allow the HPA axis to recover over weeks or months. An increase in dose may also be required during periods of stress e. There are several methods for tapering oral corticosteroids Table 7. The majority of patients respond initially to levodopa and its use improves the quality of life. After two years or more, benefit is reduced as the disease progresses and late complications emerge. If antiparkinsonian drug therapy is reduced abruptly, or discontinued, a symptom complex resembling neuroleptic malignant syndrome can occur Table 8.

Follow us on facebook. Decision support for health professionals ». South Island general practice support ». Practice acquisition and careers in health ». Click here to register ». Forgot your login? Login to my bpac. Remember me. A practical guide to stopping medicines in older people The majority of older people who require drug therapy take multiple medicines. In this article Polypharmacy increases the risk of adverse effects and medicine interactions How do you decide which medicines can be stopped?

What are the likely consequences of stopping medicines? How to stop medicines Specific guidance on stopping medicines References In this article.

Key concepts The majority of older people who require drug therapy take multiple medicines Withdrawing medicines may be the best clinical decision Factors to consider when deciding if a medicine can be stopped include the wishes of the patient, clinical indication and benefit, appropriateness, duration of use, adherence and the prescribing cascade Only stop or reduce one medicine at a time Tapering the dose helps reduce the likelihood of an adverse withdrawal event.

These will also help if you have high blood pressure. There are a number of things you can do to help prevent migraines. This includes working out what things trigger an attack so you can avoid them.

Page last reviewed: 19 March Next review due: 19 March Atenolol On this page About atenolol Key facts Who can and cannot take atenolol How and when to take it Side effects How to cope with side effects Pregnancy and breastfeeding Cautions with other medicines Common questions. About atenolol Atenolol belongs to a group of medicines called beta blockers.

This medicine is only available on prescription. Help us improve our website Can you answer a quick question about your visit today? Atenolol slows down your heart rate and makes it easier for your heart to pump blood around your body. It can make you feel dizzy, sick or tired, or give you constipation or diarrhoea. These side effects are usually mild and short-lived. Your very first dose of atenolol may make you feel dizzy, so take it at bedtime.

After that, if you do not feel dizzy, you can take it in the morning. Atenolol is known by the brand name Tenormin. Other brand names include Tenif for atenolol mixed with nifedipine and Co-tenidone atenolol mixed with chlortalidone.

To make sure it's safe for you, tell your doctor before starting atenolol if you have: had an allergic reaction to atenolol or any other medicine in the past low blood pressure or a slow heart rate serious blood circulation problems in your limbs such as Raynaud's phenomenon , which may make your fingers and toes tingle or turn pale or blue metabolic acidosis - when there's too much acid in your blood lung disease or asthma Tell your doctor if you're trying to get pregnant, are already pregnant or breastfeeding.

You'll usually take atenolol once or twice a day. It's a good idea to leave 10 to 12 hours between doses if you can. Dosage How much you take depends on why you need atenolol. How to take it Atenolol does not usually upset your tummy, so you can take it with or without food. Swallow the tablets whole with a drink of water. What if I forget to take it? If you often forget doses, it may help to set an alarm to remind you. What if I take too much?

Side effects often improve as your body gets used to the medicine. Common side effects These common side effects happen in more than 1 in people. Talk to your doctor or pharmacist if these side effects bother you or last more than a few days: feeling sleepy, tired or dizzy cold fingers or toes feeling sick nausea diarrhoea constipation Serious side effects It happens rarely, but some people have serious side effects when taking atenolol.

Tell a doctor straight away if you have: shortness of breath with a cough that gets worse when you exercise like walking up stairs , swollen ankles or legs, chest pain, or an irregular heartbeat - these can be signs of heart problems trouble breathing, cold sweats and sudden, sharp chest pain that gets worse when you cough or take deep breaths - these can be signs of lung problems a fast heart rate, a high temperature, trembling and confusion - these can be signs of a thyroid problem Serious allergic reaction In rare cases, atenolol may cause a serious allergic reaction anaphylaxis.

Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. What to do about: feeling sleepy, tired or dizzy - as your body gets used to atenolol, these side effects should wear off.

If atenolol makes you feel dizzy, sit or lie down until you feel better. Do not drive or operate machinery until you feel OK again. Try to avoid alcohol as it'll make you feel worse. Do not smoke or have drinks with caffeine in - this can make your blood vessels narrower and further restrict blood flow to your hands and feet.

Try wearing mittens they're warmer than gloves and warm socks. Do not wear tight watches or bracelets. It might help to take your atenolol after a meal or snack. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. Try to exercise more regularly by going for a daily walk, for example.

If this does not help, talk to your pharmacist or doctor. Atenolol is not usually recommended in pregnancy. Atenolol and breastfeeding If your doctor or health visitor says that your baby's healthy, it's OK to take atenolol while breastfeeding. They may recommend a different medicine for your blood pressure. Non-urgent advice: Tell your doctor if you're:. There are some medicines that may interfere with the way atenolol works.

Important: Medicine safety Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. How does atenolol work? Atenolol is a type of medicine called a beta blocker.

We do not fully understand how atenolol prevents migraines. How long does atenolol take to work? How long will I take it for? This depends on why you're taking atenolol. Is it safe to take for a long time? Atenolol is generally safe to take for a long time. What will happen if I stop taking it? Talk to your doctor if you want to stop taking atenolol. Stopping atenolol suddenly may make your health problem worse. How does atenolol compare with other heart medicines?

They work in a different way from beta blockers and include: ACE inhibitors - for example, ramipril and lisinopril angiotensin receptor blockers - for example, candesartan calcium channel blockers - for example, amlodipine diuretics medicines that make you pee more - for example, furosemide Beta blockers are not usually the first choice treatment for high blood pressure. The medicine your doctor prescribes depends on your age and ethnicity.

How does it compare with other medicines for preventing migraine? Ask your doctor or pharmacist which medicine is best for you. Will I need to stop atenolol before surgery? Can I drink alcohol with it? Is there any food or drink I need to avoid?

You can eat and drink normally while taking atenolol. Will it affect my contraception? Atenolol will not stop your contraception working.

For people with an overactive thyroid hyperthyroidism : Atenolol may mask important signs of an overactive thyroid, including a fast heartbeat. If you stop taking this drug suddenly, it may get worse and could be life threatening. For pregnant women: Atenolol is a category D pregnancy drug. That means two things:. Atenolol use in the second trimester of pregnancy has been associated with birth of babies who are smaller than normal.

Also, newborns of mothers who took atenolol at the time of birth may be at risk of hypoglycemia lower than normal blood sugar levels and bradycardia slower than normal heartbeat. If you take atenolol and are considering having a baby, or if you are pregnant, talk to your doctor right away.

Atenolol is not the only medication that treats high blood pressure. Other drugs have fewer adverse effects during pregnancy and breastfeeding. Your doctor will be able to tell you if a different drug or a dose adjustment is an option for you. For women who are breastfeeding: Atenolol is absorbed into breast milk and could be passed to a child who is breastfed.

Newborns who breastfeed from mothers who take atenolol are also at risk of hypoglycemia and bradycardia. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:. This medication has not been studied in children. It should not be used in children under the age of 18 years. There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A typical adult dosage may cause levels of the drug to be higher than normal in your body.

When this drug is used after a heart attack, the dosage is highly individualized. It depends on the cause and the effects of the heart attack. Your doctor will monitor your blood pressure and how your heart is responding, and may adjust your dosage. This drug is often started in the hospital.

Atenolol is often dosed at mg per day, given once a day or in two divided doses. The dosage is gradually adjusted if needed. For seniors: Seniors may need a smaller dosage of atenolol at first because they can be more sensitive to the way medications act in their body.

Also, as people age, they sometimes have a harder time clearing drugs from their body. After a low initial dosage, their dosage may then increase gradually. For people with kidney disease: Kidney disease can make it more difficult for you to clear this drug from your body.

Having kidney disease may affect your dosage. Talk to your doctor about the best dosage for you. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. Always speak with your doctor or pharmacist about dosages that are right for you. Atenolol oral tablet is used for long-term treatment. If you stop taking it suddenly: If you suddenly stop taking atenolol for high blood pressure, chest pain, or after a heart attack, you raise your risk of heart attack.

Your blood pressure might fluctuate too often. That might increase your risk for a heart attack. If you miss a dose: If you miss a dose, just take the next dose as planned. How to tell if the drug is working: You can tell that atenolol is working if it lowers your blood pressure.

Because atenolol can lower blood pressure, your doctor may ask that you periodically check your blood pressure while taking it. Let your doctor know if you experience blood pressure readings that are either too high or too low while taking atenolol. A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled.

Your doctor will write the number of refills authorized on your prescription. There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.