Pharmacokinetics in children

The elimination half-life in children older than 5 years is on average between 3.5 and 7 hours [Buck et al.]. In neonates it is between 10.5 and 34.6 hours [Rubin et al.].

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Hypertension, supraventricular arrhythmias, Marfan syndrome
Oral 1 month up to 18 years Initial dose: 0.5 - 1 mg/kg/day in 1 - 2 doses. Maintenance dose: Depending on the haemodynamic response, the initial dose can be raised to 1 - 4 mg/kg/day in 1 - 2 doses. Max: 250 mg/day.

Haemangiomas
Oral 1 month up to 14 months 1 mg/kg/day in 1 dose

Renal impaiment in children > 3 months

Adjustment in renal impairment as specified:

GFR 50-80 ml/min/1.73 m2

Adjustment not necessary.

GFR 30-50 ml/min/1.73 m2

Adjustment not necessary.

GFR 10-30 ml/min/1.73 m2

50 percentage of single dose and dosing interval : 12 up to 24 uur

GFR < 10 ml/min/1.73 m2

Generalized recommendations cannot be given

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Dyspnoea, cold extremities, provocation of congestive heart failure or hypoglycaemia (without symptoms: take care with diabetes patients) and nightmares. Few central side effects.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications in children

Sinus bradycardia, AV block, hypotension and asthma.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Great caution is needed in concomitant use of verapamil (Isoptin) because of the risk of arrhythmia. In cases of hypertension, start with a low dose and increase it depending on the blood pressure. Try to halve the dose after six months’ success. Always phase the dosage out slowly.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

• CARDIOVASCULAR SYSTEM
• BETA BLOCKING AGENTS

BETA BLOCKING AGENTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Beta blocking agents, non-selective
	Propranolol Related Medicines Menu">	C07AA05
	Sotalol Related Medicines Menu">	C07AA07

Beta blocking agents, selective
	Bisoprolol Related Medicines Menu">	C07AB07
	Esmolol Related Medicines Menu">	C07AB09
	Metoprolol Related Medicines Menu">	C07AB02

Alpha and beta blocking agents
	Carvedilol Related Medicines Menu">	C07AG02
	Labetalol Related Medicines Menu">	C07AG01

References

1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
2. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents., The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents., Pediatrics, 2004, Aug;114(2 Suppl 4th Report), 555-76
3. Ko JK, et al, Long-term efficacy of atenolol for atrioventricular reciprocating tachycardia in children less than 5 years old, Pediatr Cardiol, 2004, Mar-Apr;25(2), 97-101
4. Mehta AV, et al, Long-term efficacy and safety of atenolol for supraventricular tachycardia in children, Pediatr Cardiol, 1996, Jul-Aug;17(4), 231-6
5. Trippel DL, et al, Atenolol in children with ventricular arrhythmias, Am Heart J, 1990, Jun;119(6), 1312-6
6. Buck ML, et al, Pharmacokinetics and pharmacodynamics of atenolol in children, Clin Pharmacol Ther., 1989, Dec;46(6, 629-33
7. Trippel DL, et al, Atenolol in children with supraventricular tachycardia, Am J Cardiol, 1989, Jul 15;64(3), 233-6
8. Rubin PC, et al, Atenolol elimination in the neonate, Br J Clin Pharmacol, 1983, Dec;16(6), 659-62
9. Lacro RV et al., Atenolol versus losartan in children and young adults with Marfan’s syndrome, N Eng J Med, 2014, Nov;371(22), 2061-71
10. Ábarzúa-Araya A, et al, Atenolol versus propranolol for the treatment of infantile hemangiomas: a randomized controlled study, J Am Acad Dermatol, 2014, Jun;70(6), 1045-9
11. Raphaël MF, et al, Atenolol: a promising alternative to propranolol for the treatment of hemangiomas., J Am Acad Dermatol, 2011, 2011, Aug;65(2), 420-1
12. Lurbe E, et al, Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension, J Hypertens, 2009, Sep;27(9),, 1719-42
13. Ruitenberg G et al, Ulcerated infantile haemangiomas: the effect of the selective beta-blocker atenolol on wound healing, Br J Dermatol, 2016, 175, 1357-1360
14. Di Salvo G, et al., Atenolol vs enalapril in young hypertensive patients after successful repair of aortic coarctation, J Hum Hypertens, 2016, 30, 363-7
15. Bayart CB, et al., Atenolol versus propranolol for treatment of infantile hemangiomas during the proliferative phase: a retrospective noninferiority study, Pediatr Dermatol, 2017, 34, 413-21
16. Tasani M, et al., Atenolol treatment for infantile haemangioma, Br J Dermatol, 2017, 176, 1400-2
17. Calderón-Castrat X, et al., Oral Atenolol for Infantile Hemangioma: Case Series of 46 Infants., Actas Dermosifiliogr, 2020, 111(1), 59-62

Changes

Therapeutic Drug Monitoring

Overdose