propranolol vs atenolol comparison

Propranolol vs Atenolol: Beta Blockers Compared

When researching beta blockers you will quickly learn there are many on the market today with similar profiles, uses, and mechanisms of action. Two popular options are propranolol and atenolol which are commonly used to treat a variety of conditions from high blood pressure to migraines and even performance anxiety in some cases.  This article will breakdown the similarities and differences between the two compounds to give you a more detailed understanding to help you, in conjunction with your doctor, find the right treatment for your situation.

What Are Beta Blockers?

Beta blockers are a class of drugs that work by blocking the effects of the hormone adrenaline in your body which can cause the heart rate to reduce and in turn lower the body’s blood pressure.  Beta blockers are some of the mostly commonly prescribed drugs in America today to treat irregular heartbeat, heart failure, chest pain, heart attacks, migraines, tremors, and even anxiety is some cases.

What is Propranolol?

Propranolol is one of the more popular versions of beta blockers that has been well studied over a long history of usage.  Propranolol has been around since the 1960s and have a long history of research and documented studies behind it.  Originally created to treat chest pain and high blood pressure, it was soon found that it could do even more.  Propranolol began to be used in situations to treat ailments like hand tremors, migraine headaches, and even anxiety as well.  In very recent times, studies have emerged that indicate that Propranolol might even help aid patients that have PTSD.  So in general it’s a well-studied and versatile drug that can treat a variety of ailments with a relatively low risk profile.

What is Atenolol?

Atenolol is a beta blocker that was patented shortly after propranolol in 1969 and approved for medical treatment in 1975.  It’s commonly known by its branded name Tenormin.  Atenolol is a cardio-selective beta blocker that primarily binds to b1 receptors in the heart and is used to primarily treat heart issues and problems. In more recent years it has been identified to potentially increase the risk of type two diabetes and it’s usages has been slowing trending down (although is was still one of the most commonly prescribed medications in the US in 2017)

Drug Differences Between Propranolol and Atenolol

The major difference between the two is that fact that atenolol is a cardio-selective drugs that primarily binds to beta receptors in the heart, whereas propranolol is nonselective and binds equally to all beta receptors in the body as well as crosses the blood brain barrier.

Differences in Treatment Uses

Both drugs are most commonly used for the treatment and management of symptoms of heart attack and high blood pressure.  Propranolol and atenolol are both also sometimes used off label for event driven anxiety, migraine prevention, and the treatment of tremors.  Both drugs have also been indicated to help alleviate minor symptoms of alcohol withdrawal including tremors and anxiety.

Differences in Side Effects and Risk Profiles

While both drugs have similar risk profiles and side effects, atenolol is known to have slightly less risk due to it’s selective nature and less impact on the CNS and brain.

Atenolol Common Side Effects

  • Tiredness
  • Low blood pressure (hypotension)
  • Slow heart rate
  • Cold extremities
  • Dizziness upon standing
  • Depression
  • Nausea
  • Dreaming
  • Drowsiness
  • Diarrhea
  • Fatigue
  • Leg pain
  • Lethargy
  • Lightheadedness
  • Spinning sensation (vertigo)
  • Shortness of breath
  • 2°/3° atrioventricular (AV) block

Propranolol Common Side Effects

  • nausea,
  • vomiting,
  • diarrhea,
  • constipation,
  • stomach cramps,
  • decreased sex drive,
  • impotence,
  • difficulty having an orgasm,
  • sleep problems (insomnia), and
  • feeling tired

More Serious Risks of Both Drugs

For both drugs more serious side effects and risks can occur, if you experience any of these side effects it’s best to contact your doctor immediately.

  • Allergic reactions (skin rash; itching; hives; swelling of your face, lips or tongue)
  • Breathing problems
  • Changes in blood sugar
  • Cold hands or feet
  • Nightmares or trouble sleeping
  • Dry, peeling skin
  • Hallucinations
  • Muscle cramps or weakness
  • Slow heart rate
  • Swelling of your legs or ankles
  • Sudden weight gain
  • Vomiting
  • Dizziness, light-headedness, or loss of consciousness in some rare cases

Differences in Drug Interactions

Both drugs have a risk of negative interactions and you should talk to a doctor and disclose all medications you are taking to prevent any harmful or adverse reactions.

Differences in Half Life and How Long the Drug Lasts

The half life of propranolol is 3 to 6 hours with effects usually kicking in within an hour of taking it. Atenolol is slightly longer with a 6 to 7 hour half life and its effects usually become noticeable 1 hour after ingesting.

Differences in Individuals with Increased Risk

Both drugs have a similar risk and should not be taken by those with preexisting conditions, namely diabetes and breathing problems.  Also pregnant women should not take these medications. As always, it’s important to talk to you doctor and be open about all other medications you are taking to prevent dangerous interactions.

Differences in Common Dosing and Scheduling

Dosages will depend on individuals’ cases and a variety of other factors including treatment goals, medical history, and body weight.

Propranolol Common Dosages

For heart issues or ongoing migraine prevention higher dosages in the 80mg – 240mg per day range of propranolol are commonly used. For anxiety and public speaking much small dosages around 10mg -20mg are usually effective on an as needed basis.

Atenolol Common Dosages

The usual dosage of atenolol is 100mg per day (usually split into two 50mg dosages).  Again higher dosages are sometimes needed for treatment of high blood pressure and heart conditions and lesser dosages are sometimes used off label for anxiety or the treatment of symptoms of alcohol withdrawal.

Risk of Withdrawals and Discontinuing treatment

While both of these drugs are non-controlled and have little risk of physical addiction, you should always work closely with a doctor before discontinuing long term treatment as a rebound in blood pressure can occur in some cases.

Conclusion: Making the Right Decision for Your Specific Situation

Finding the right drug for you depends on your specific situation and can be decided through trial and error as well as through discussions with a doctor. If you are interested in seeing if propranolol is right for you can connect you with U.S. licensed doctors who can issue prescriptions and have medications shipped to your if appropriate.

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