Atenolol vs. Carvedilol
See how Atenolol and Carvedilol compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Atenolol treats hypertension, angina, and stable heart attacks, while carvedilol also treats chronic heart failure and improves survival after a heart attack with reduced heart function.
Atenolol is taken once a day, while carvedilol is taken twice a day with food and needs a slower, multi-step dose increase.
Both drugs can cause dizziness and fatigue, but carvedilol carries a higher risk of low blood pressure, especially when standing up.
Atenolol vs. Carvedilol Drug Summary
Atenolol
Atenolol is a beta-1 selective beta-blocker used to lower blood pressure, treat angina, and manage stable heart attacks. It works by blocking beta-1 receptors in the heart to slow heart rate and reduce the heart's workload. It is taken as a tablet once a day, usually starting at 50 mg.
Carvedilol
Carvedilol is a combined alpha- and beta-blocker used to treat high blood pressure, chronic heart failure, and to reduce the risk of death after a heart attack with weakened heart function. It blocks beta-1, beta-2, and alpha-1 receptors to lower blood pressure and ease strain on the heart. It is taken as a tablet twice a day with food, starting at a low dose that is slowly increased.
Atenolol vs. Carvedilol Side Effects
Atenolol
Carvedilol
Atenolol vs. Carvedilol Dosage
Atenolol
Carvedilol
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | At the start |
| Maximum dose | 200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 3.125 mg twice daily | At the start |
| Maximum dose | 25 mg twice daily | If needed |
| Dose changes | 3 increases | As tolerated |
Atenolol
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | At the start |
| Maximum dose | 200 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Carvedilol
| STAGE | DOSE | WHEN |
| Starting dose | 3.125 mg twice daily | At the start |
| Maximum dose | 25 mg twice daily | If needed |
| Dose changes | 3 increases | As tolerated |
Atenolol vs. Carvedilol Indications
Atenolol
Atenolol is FDA-approved for high blood pressure, angina, and stable heart attacks. It is sometimes used off-label for other conditions, but it is not approved for heart failure.
Hypertension
Angina pectoris
Acute myocardial infarction (hemodynamically stable)
Off-label: migraine prevention and tremor
Carvedilol
Carvedilol is FDA-approved for high blood pressure, chronic heart failure, and left ventricular dysfunction after a heart attack. It is often added to other heart failure medications like diuretics and ACE inhibitors.
Essential hypertension
Chronic heart failure (ischemic or cardiomyopathic)
Left ventricular dysfunction following a heart attack
Often combined with diuretics or ACE inhibitors
Atenolol vs. Carvedilol Pros and Cons
Atenolol
Atenolol is a widely used, inexpensive beta-blocker with decades of clinical experience for hypertension and angina. It is not approved for heart failure and requires caution in kidney disease because it is cleared by the kidneys.
Pros
Once-daily dosing, no titration schedule to remember
Beta-1 selective, so less likely to affect the lungs
Long track record of use since 1981
One of the least expensive beta-blockers available
Cons
Not FDA-approved for heart failure
Requires dose adjustment in kidney disease
Contraindicated in bradycardia and higher-degree heart block
Can mask signs of low blood sugar or an overactive thyroid
Carvedilol
Carvedilol's added alpha-blocking effect gives it a broader label that includes heart failure and improved survival after a heart attack, uses atenolol does not have. That broader reach comes with a twice-daily schedule and a slower, multi-step dose increase.
Pros
FDA-approved for heart failure, not just blood pressure
Shown to reduce cardiovascular deaths after a heart attack
Extra alpha-1 blocking effect adds another way to lower blood pressure
Can be used alongside heart failure medications like diuretics
Cons
Must be taken twice a day instead of once
Must be taken with food to reduce dizziness on standing
More titration steps before reaching a maintenance dose
Higher rate of dizziness and low blood pressure on standing
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.