When to Avoid Atlin?
Atlin is contraindicated with known hypersensitivity to the substances, bradycardia, cardiogenic shock, hypotension, metabolic acidosis, severe peripheral arterial circulatory disturbances, second or third degree heart block, sick sinus syndrome, untreated phaeochromocytoma and uncontrolled heart failure.
Precaution
Atlin should be withheld in cases of untreated heart failure, till the failure has been brought under control. If congestive heart failure occurs during treatment with Atlin the drug may be temporarily withdrawn until the failure has been controlled. Atlin acts preferentially and selectively on cardiac beta 1-receptors, so it can be used in cases of chronic obstructive respiratory diseases. However increase in airways resistance may be incited in asthmatics, in such cases bronchspasm is usually reversed by the bronchodilator e.g. salbutamol (an isoprenaline).
In case of IHD (ischaemic Heart Diseases) treatment should not be discontinued abruptly. If Atlin is given simultaneously with clonidine, then clonidine should not be withdrawn until one week after Atlin withdrawal.
Anaesthesia
It is preferable to withdraw Atlin 48 hours before surgery. If the treatment is to be continued then necessary precautions must be taken.
Renal Failure
Atlin is excreted through kidney, so in case of severe renal impairment dosage should be
reduced.
Drug Interactions
Combined use of beta-blockers and calcium antagonists with negative inotropic effects e.g. verapamil, diltiazem can lead to an exaggeration of these effects particularly in-patients with impaired ventricular function and/or Sino-Atrial or Atrio-ventricular conduction abnormalities. Use with nifedipine may increase the risk of hypotension, and cardiac failure, with digoxin Atrioventricular conduction time may increase. Sympathomimetic drugs may counteract the effects of beta-blockers. Caution must be exercised when prescribing beta-b)ockers with class 1 anti- arrhythmic and anaesthetic agents.
