5 Atenolol Interactions You Should Know About

When you’re starting atenolol (Tenormin), potential interactions may be a concern. These are often managed ahead of time by your healthcare team. And some interacting medications are prescribed with atenolol on purpose, too. But even if you’ve been taking atenolol for years, potential interactions shouldn’t be overlooked.

Common atenolol interactions include calcium channel blockers and other medications that slow down your heart rate. Insulin is another potential interaction. We cover what you should know about five atenolol interactions below.

1. Calcium channel blockers

Calcium channel blockers treat high blood pressure and other heart conditions. Some calcium channel blockers, such as diltiazem (Cardizem) and verapamil slow down your heart rate. Others, such as amlodipine (Norvasc), have little effect on your heart rate.

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Atenolol is a beta blocker that works by slowing down your heart rate. When it’s combined with diltiazem or verapamil, your heartbeat can slow down too much (called bradycardia). Symptoms include lightheadedness, excessive fatigue, and fainting.

Your healthcare provider will determine whether taking these medications with atenolol is OK. For some people, this interaction can cause serious problems and should be avoided altogether.

2. Heart rhythm medications like amiodarone

Heart rhythm medications (antiarrhythmics) are used to help keep your heartbeat in a regular rhythm. Examples include amiodarone (Pacerone), disopyramide (Norpace), and propafenone (Rythmol). Like atenolol, they can slow down your heart rate.

When taken with atenolol, certain heart rhythm medications can cause bradycardia. Some combinations have resulted in severe symptoms and heart failure. For this reason, your healthcare provider may monitor your heart rate more closely if these medications are taken together. Tell them right away if you start feeling dizzy, extremely fatigued, or short of breath.

3. Digoxin

Digoxin (Lanoxin) is a medication that treats heart failure and heart rhythm problems. It works by making your heart pump harder with each beat. It also slows down your heart rate, which can increase the risk of bradycardia with atenolol.

Digoxin is sometimes prescribed along with beta blockers for heart failure. But in this case, other beta blockers are preferred over atenolol. So this combination may not be very common. But if your healthcare provider decides that you should take both medications, they may monitor your heart rate more closely.

4. Clonidine

Clonidine (Catapres, Nexiclon XR) is a medication that treats high blood pressure. It works by relaxing the blood vessels and slowing the heart rate down. It also lowers the activity of stress hormones in the brain.

Taking atenolol with clonidine isn’t necessarily a problem. You may need your heart rate checked regularly, since both medications slow your heartbeat. The more serious risk is if you stop taking clonidine abruptly while you’re taking atenolol. This can cause your blood pressure to rise very quickly.

If you’re taking atenolol and need to stop clonidine, follow your healthcare provider’s instructions. They will likely recommend you stop atenolol first, then clonidine. But keep in mind that neither medication should be stopped abruptly. Instead, your healthcare provider will usually slowly decrease your dose over time.

5. Insulin

If you’re living with diabetes, you may be prescribed insulin to help manage your blood glucose (sugar) levels. Hypoglycemia (low blood glucose) is a common insulin side effect. But beta blockers like atenolol can mask (hide) certain hypoglycemia symptoms, such as feeling shaky.

Sweating is one hypoglycemia symptom that isn’t masked by atenolol. If you notice that you’re starting to sweat, check your blood glucose levels. If they’re below 70 mg/dL, follow the instructions you’ve been given to bring it back up safely.

It’s also possible that your usual insulin dose may not work as well after you start taking atenolol. If your blood glucose levels are higher than usual, let your healthcare provider know. They may need to adjust your insulin dose.

When should you contact your healthcare provider about atenolol interactions?

It’s best to address potential atenolol interactions upfront. Your healthcare team should check for these before prescribing or dispensing atenolol to you. Be sure to have a complete list of your medications and ask any questions you have about potential interactions.

But if you’re already taking atenolol, it’s not too late to check with your healthcare provider. Your pharmacist is also a good resource to provide information on drug interactions. They can help address any that may be relevant to you.

If you’re having symptoms of bradycardia, contact your healthcare provider right away. These include excessive fatigue, severe dizziness or lightheadedness, or fainting. In some cases, you could be experiencing the effects of an interaction. If your symptoms seem life threatening, go to the nearest emergency room or call 911.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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