Atenolol
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
- Atenolol
- Atenolol: From Hypertension and Myocardial Infarction to Posterolateral Myocardial Infarction
Atenolol: From Hypertension and Myocardial Infarction to Posterolateral Myocardial Infarction
One-Sentence Summary
Atenolol is a beta-1 selective blocker, originally used to treat hypertension and myocardial infarction. The TxGNN model predicts it may be effective for posterolateral myocardial infarction, but there are currently 0 clinical trials and 0 publications supporting this specific prediction. The prediction is mostly an anatomical subtype of an already-approved indication.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Hypertension, myocardial infarction (from the knowledge graph; the Singapore licences carry no indication text) |
| Predicted New Indication | Posterolateral myocardial infarction |
| TxGNN Prediction Score | 99.87% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 17 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism-of-action data is not available in the data compiled for this report. From established pharmacology, atenolol is a cardioselective beta-1 blocker. It lowers heart rate, myocardial contractility and oxygen demand, and it suppresses renin release.
Atenolol is already used for myocardial infarction. Posterolateral MI is an anatomical subtype of that condition, so the high score mostly reflects closeness in the disease ontology rather than a new repurposing signal. Beta-1 blockade is plausible across MI locations, but no study specific to this subtype was supplied.
Other Predicted Indications (Ranks 2–10)
| Rank | Predicted Indication | Score | Evidence Level | Assessment |
|---|---|---|---|---|
| 2 | Posteroinferior myocardial infarction | 99.87% | L4 | MI subtype. One small 1985 crossover study comparing atenolol with diltiazem (23 patients) is indirect and weak. |
| 3 | Malignant renovascular hypertension | 99.85% | L4 | Plausible through renin suppression. The only literature is a 2008 case report of hypertension from aortic coarctation and renal artery stenosis in a teenager with neurofibromatosis type 1, which does not establish efficacy. |
| 4 | Malignant hypertensive renal disease | 99.85% | L5 | No evidence. Malignant hypertension usually needs acute parenteral therapy. |
| 5 | Pulmonary hypertension, unclear multifactorial mechanism | 99.84% | L5 | No evidence. Beta-blockers are used cautiously in pulmonary hypertension. |
| 6 | Pulmonary hypertension owing to lung disease and/or hypoxia | 99.84% | L4 | Mostly off-topic or preclinical literature, with conflicting rodent findings. Possible harm in hypoxic lung disease. |
| 7 | Septal myocardial infarction | 99.84% | L4 | MI subtype. One small 1981 thallium-scan study is indirect. |
| 8 | Braddock syndrome | 99.80% | L5 | No evidence and no mechanistic link identifiable. |
| 9 | Chronic pulmonary heart disease | 99.04% | L4 | Literature is general hypertension and beta-blocker material, plus cautions about beta-blockers in chronic lung disease. |
| 10 | Primary hereditary glaucoma | 98.84% | L5 | Class-level rationale only (topical beta-blockers lower eye pressure). Oral atenolol is unsupported. |
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
For the top prediction (posterolateral myocardial infarction), currently no related literature is available.
The closest supporting publications for the closely related predictions are listed below.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 3901170 | 1985 | RCT (small, crossover, single-blind) | La Revue de médecine interne | Atenolol 200 mg vs diltiazem 240 mg in 23 patients 4 weeks after posteroinferior or anterior MI, comparing anti-ischaemic activity on exercise testing |
| 7257500 | 1981 | Clinical imaging study | Zeitschrift für Kardiologie | Thallium-201 stress scintigraphy in 14 coronary artery disease patients after intravenous atenolol 5 mg; regional perfusion changes |
| 11219471 | 2001 | RCT | Clinical Therapeutics | Telmisartan vs atenolol for mild to moderate hypertension over 26 weeks (indirect) |
| 14520850 | 2003 | Clinical study | Terapevticheskii Arkhiv | Atenolol, metoprolol and bisoprolol in isolated systolic hypertension with diabetes and/or COPD (indirect) |
| 30191469 | 2018 | Retrospective cohort | Cardiology and Therapy | Cardiovascular hospitalisation risk with nebivolol vs atenolol and metoprolol in hypertensive patients |
| 38700308 | 2023 | Review | J Assoc Physicians India | Role of beta-blockers in hypertension management |
| 15881093 | 2005 | Review | Terapevticheskii Arkhiv | Respiratory risks of long-term atenolol in ischaemic heart disease with COPD |
| 8590992 | 1995 | Preclinical (rat) | British Journal of Pharmacology | Propranolol reduced hypoxia-induced right heart hypertrophy by 65% |
| 6212672 | 1982 | Preclinical (rabbit) | Journal of Physiology | Hypoxic cardiac hypertrophy was not inhibited by cardioselective or non-selective beta-blockers |
| 18454714 | 2008 | Case report | Nefrología | Hypertension from aortic coarctation and renal artery stenosis in a teenager with neurofibromatosis type 1 |
Singapore Market Information
Atenolol has 17 valid single-ingredient registrations in Singapore and none are cancelled. The licences carry no approved-indication text. Five main authorisations are shown below.
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN08753P | ATENOLOL TABLET 50 mg (Beacons Pharmaceuticals) | Film-coated tablet | Not stated |
| SIN08755P | ATENOLOL TABLET 100 mg (Beacons Pharmaceuticals) | Film-coated tablet | Not stated |
| SIN07697P | ATENOLOL TABLET 50 mg (Sunward Pharmaceutical) | Film-coated tablet | Not stated |
| SIN03630P | APO-ATENOL TABLET 50 mg (Apotex) | Tablet | Not stated |
| SIN07161P | VASCOTEN 50 TABLET 50 mg (Medochemie) | Tablet | Not stated |
Safety Considerations
- Contraindications suggested by the knowledge graph (not label text; to be verified against the package insert): atrioventricular block, asthma (intrinsic and allergic), Raynaud disease, anaphylaxis, diabetes mellitus (type 1, type 2 and diabetic ketoacidosis), liver failure, pancreatitis, systemic lupus erythematosus, psoriasis, gout and hyperuricaemia, anuria, hypercalcaemia, nephrocalcinosis, phosphorus metabolism disease, potassium deficiency, and anxiety, neurotic and dysthymic disorders.
- Drug interactions: the interaction query returned 100 records. Most of those displayed are Moderate: epinephrine, corticosteroids (hydrocortisone, triamcinolone, betamethasone, budesonide), hyoscyamine, atropine, bupropion, morphine, acetohexamide, and calcium salts (acetate, carbonate, citrate, gluconate, lactate and others). Minor interactions include acetylsalicylic acid, aluminium hydroxide and attapulgite.
- Indication-specific cautions: beta-blockers can reduce cardiac output and exercise capacity in pulmonary hypertension, and may worsen outcomes in chronic lung disease. They can also be hazardous in bilateral renal artery stenosis when combined with other agents that reduce renal perfusion. Beta-blocker overdose can be severe or fatal.
Package insert warnings and contraindications were not available, so please refer to the package insert for the official safety information.
Conclusion and Next Steps
Decision: Hold
Rationale: The top prediction, posterolateral MI, is an anatomical subtype of an indication atenolol already has, so it adds little new repurposing value. No trials or directly relevant literature exist for it. The other predictions are supported only by indirect, old or preclinical evidence, or by none at all. Several of them (pulmonary hypertension, chronic pulmonary heart disease) carry plausible safety concerns.
To proceed, the following is needed:
- HSA package insert warnings and contraindications. This is a blocking gap and prevents safety screening.
- Mechanism-of-action data, for example from DrugBank.
- A clinical question that adds value beyond the existing MI indication. Outcome data stratified by MI location could answer it.
- For any non-MI prediction, a targeted literature search and a risk-benefit review, particularly for pulmonary hypertension and lung-disease settings.
- Route compatibility and similarity-to-original assessments, which are still pending.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.