Pharmacist's advice on anti hypertensive drugs: Atenolol

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Dear friends

I am giving below some information on drug
advice. Each drug advice is divided into two parts, one is information that the
pharmacist must have and the second is information for the patient. In all the
drugs for hypertension, two instructions come commonly. One is about avoiding
grapefruit juice in breakfast when someone is taking antihypertensives. This
direction is incorporated in our advice, based on research reports [1] , which
report that there is a drug-food interaction between grapefruit juice and
antihypertensives. Grapefruit is not our grape. Grapefruit looks similar to our
orange. The second point is regarding keeping at least one hour gap between
antihypertensives and any other drugs. This is because it is reported [2] that
among all categories of drugs, it is antihypertensives that show maximum number
of drug interactions.

Drug advice


Information for pharmacist:

  1. Extended release dosage forms should be swallowed whole without
    crushing, breaking or chewing.
  2. Advice on:

Importance of diet, possible
need for sodium restriction and weight management.

Importance of taking medication
and keeping physician's appointment even if the patient feels fine.

Possible need for lifelong
therapy as atenolol does not cure, but controls hypertension.

Check with physician before
discontinuing medication.

Serious consequences of
untreated hypertension.

Information for patient:

  1. Take breakfast at 7:30 a.m. and atenolol at 8:00 a.m.
  2. Take regularly at the same time.
  3. Do not take grapefruit juice in breakfast, when you are taking
  4. Do not stop taking without consulting with your physician.
  5. Do not miss a dose. In case you miss a dose, take it
    immediately. If it is within eight hours of the next dose, then take only
    the next regular dose.
  6. Do not combine this medicine with any other. Give at least one
    hour gap between this tablet and any other medicine.
  7. Consult doctor before taking any other medicine like OTC
    products for common cold, cough etc along with this medicine.


Pharmaceutical Research, 1999;16:478

Biopharmaceutics and Clinical pharmacokinetics, Milo Gibaldi, Percentage of
hospitalized patients, categorized by drug group, who experienced adverse drug
reactions, (Data from May,F.E., Stewart, R.B., and Cluff,l.E., 4th edition; page 306; Pharmabook syndicate.

3. Advice for the patient: Drug information in
lay language; USP DI; 1995, 15th edition; pg: 406-407.


About the Author

Niklesh Rao V's picture
Author: Niklesh Rao V


Prof. J. Vijaya Ratna's picture

Niklesh Your incorporation about grapefruit juice is good. Unfortunately there is not much research in India on fruit juice and antihypertensive drugs interactions. Dr. Bennet has reported a lot of things on food-drug interactions. You must browse the Indian research to look for work on food-drug interactions. Vijaya Ratna
Niklesh Rao V's picture

Thank you ma'am. I will try to present all the information I can gather ma'am.

Regards, Niklesh Rao V

P.V.ABHIGNA's picture

Niklesh, Thats quite interestin to kno abt grape fruit restriction for hypertensive patients.What actually happens ,I mean does it bring down the effect of the tablet or does it cause some other kind of interactions in the body???


Niklesh Rao V's picture

Dear Abhigna, grapefuit juice has been found to interact with a lot of anti hypertensive drugs, it tends to alter the metabolism of certain drugs and thus interacts pharmacodynamically. You can get more detailed information following the reference I gave at the end of my blog and also this Thank you for asking.

Regards, Niklesh Rao V

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