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VASCOTEN must not be used in patients with untreated cardiac failure, but may be introduced with care when the failure has been brought under control. Where congestive cardiac failure appears during treatment with VASCOTEN, the drug may be temporarily withdrawn until the failure has been controlled. One of the pharmacological actions of VASCOTEN is to reduce heart rate. In the rare instances that symptoms may be attributable to the slow heart rate, the dose may be reduced.
VASCOTEN acts preferentially on cardiac beta-receptors. It can be used in patients with chronic obstructive airways disease. However, occasionally some increase in airways resistance may occur in asthmatic patients. In contrast to non-selective beta-blockers this bronchospasm may usually be reversed by commonly used dosage of bronchodilator preparations such as salbutamol or isoprenaline.
In patients suffering from ischaemic heart disease as with other beta-blocking agents, treatment with VASCOTEN should not be discontinued abruptly.
If VASCOTEN and clonidine are given concurrently the clonidine should not be discontinued until several days after the withdrawal of the beta-blocker (see also prescribing information on clonidine).
Anaesthesia: as with all beta receptor blocking drugs it may be decided to withdraw VASCOTEN before surgery. In this case 48 hours should be allowed to elapse between the last dose and anaesthesia. lf treatment is continued care should be taken when using anaesthetic agents such as ether, cyclopropane and trichloroethylene. Vagal dominance, if it occurs, may be corrected with atropine (1-2mg i.v.).
Use in Pregnancy: Like all other drugs. Atenolol should not be given in pregnancy unless its use is essential. There is no evidence of teratogenicity in animal studies.
