Atenolol and Repaglinide: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 15, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Repaglinide
Atenolol
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Repaglinide (Prandin) is a diabetes pill that lowers your blood sugar. Atenolol (Tenormin) is a beta-blocker used for blood pressure and heart problems. When you take them together, two things can happen. Your blood sugar may swing a little higher or lower than usual. Just as important, atenolol can hide some of the early warning signs of low blood sugar, like a fast or pounding heartbeat, so a low can sneak up on you.
The good news is that you will usually still notice sweating, and your care team can manage this easily. Do not stop either medicine on your own. Checking your sugar a bit more often and talking with your pharmacist or doctor is the best plan.
Effect: Beta-blocker plus repaglinide (an insulin secretagogue) can cause hypo- or hyperglycemia and, importantly, may blunt adrenergic warning signs of hypoglycemia.
- Mechanism: Beta blockade alters glucose homeostasis and can impair glucose recovery; it masks tachycardia (though diaphoresis is usually preserved).
- Direction/magnitude: Variable glycemic effect; masking of symptoms is the key concern. Atenolol is beta-1 selective, so risk is somewhat lower than with nonselective agents.
- Onset: Delayed. Evidence: Probable. Severity: Moderate.
- Management: Increase frequency of glucose monitoring; individualize repaglinide dosing as needed. If atenolol is withdrawn, watch for loss of glycemic control.
What happens
Hypoglycemia or hyperglycemia; decreased symptoms of hypoglycemia
Interaction Deep Dive
Using antidiabetic medications together with beta-blockers can produce either hypoglycemia or hyperglycemia, and it may also mask the warning signs of hypoglycemia23. While tachycardia may be blunted, other hypoglycemic manifestations such as dizziness and sweating are generally not affected1. Beta-blockers that are nonselective have the potential to intensify the hypoglycemia caused by insulin and to hinder the return of serum glucose to normal levels. In individuals who have both heart failure and diabetes, hyperglycemia may deteriorate7. It may become necessary to monitor glucose more often or to modify the dose of the antidiabetic drug23. During combined use, watch carefully for indications of hypoglycemia, and should the beta-blocker be discontinued, be alert for a loss of glycemic control4.
Why it happens (mechanism)
Altered glucose metabolism and beta blockade
How to manage this interaction
This combination is commonly used and manageable. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Monitor more often: Your team may ask you to check your blood sugar more frequently, especially when starting or changing doses.
- Know your signs: A racing heartbeat may be muted, so pay attention to sweating, shakiness, or confusion as signs of a low.
- Dosing: Your repaglinide dose may need to be adjusted and individualized by your care team.
- If atenolol is stopped: Tell your team, since your blood sugar control could shift.
Raise any lows or highs with your pharmacist or doctor.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In elderly diabetic patients receiving either insulin or sulfonylureas, the particular antihypertensive agent selected had little influence on the risk of hypoglycemia; however, after accounting for other risk factors, the lowest risk was observed with cardioselective beta blockers and the highest with non-cardioselective beta blockers, while other antihypertensive agents fell in between (N=13,559) 5.
b) In patients with hypertension and non-insulin dependent diabetes, beta blockers produced a worsening of long-term glycemic control, whereas alpha blockade and ACE inhibitors did not. Beta blockade also led to some unfavorable changes in the lipid profile. These effects were particularly evident with propranolol. Using an alpha blocker together with the beta blocker prevented the worsening attributable to beta blockade 6.
Common questions
Can I take Atenolol and Repaglinide together?
Taking repaglinide with atenolol can shift your blood sugar and can hide the fast-heartbeat warning of a low, so check your sugar more often and watch for sweating or shakiness. Keep both medicines and let your care team fine-tune your plan. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atenolol and Repaglinide interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Atenolol and Repaglinide interaction managed?
This combination is commonly used and manageable. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Monitor more often: Your team may ask you to check your blood sugar more frequently, especially when starting or changing doses. Know your signs: A racing heartbeat may be muted, so pay attention to sweating, shakiness, or confusion as signs of a low. Dosin… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Atenolol or Repaglinide need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (7)
- Product Information: TENORMIN(R) oral tablets, atenolol oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2012. DailyMed
- Product Information: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015. DailyMed
- Product Information: AMARYL(R) oral tablets, glimepiride oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. DailyMed
- Product Information: Glynase(R) PresTab(R) oral micronized tablets, glyburide oral micronized tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2013. DailyMed
- Shorr RI, Ray WA, Daugherty JR, et al: Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278:40-43. DOI
- Whitcroft IA, Thomas JM, Rawsthorne A, et al: Effects of alpha and beta adrenoceptor blocking drugs and ACE inhibitors on long term glucose and lipid control in hypertensive non-insulin dependent diabetics. Horm Metab Res Suppl 1990; 22:42-46.
- Product Information: COREG CR(R) extended-release oral capsules, carvedilol phosphate extended-release oral capsules. GlaxoSmithKline, Research Triangle Park, NC, 2011. DailyMed
Keep reading about Repaglinide
Keep reading about Atenolol
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