Adult Dosing
Angina pectoris
- Start 40 mg/day PO; increase in 40-80 mg/day at 3-7 days intervals until optimal response achieved
- Maintenance dose: 40-80 mg/day
- If required 160 or 240 mg/day may be given
Notes:- The usefulness and safety in angina pectoris of dosage >240 mg/day have not been established
- For discontinuation of treatment reduce the dosage gradually over a period of 1-2 wks
Hypertension
- Start 40 mg/day PO; increase in 40-80 mg increments until optimal response is achieved
- Maintenance dose: 40-80 mg PO daily
- If required 240 or 320 mg daily may be needed
Note: For discontinuation of treatment reduce the dosage gradually over a period of 1-2 wks
Supraventricular arrhythmias [Non-FDA Approved]
Note: For discontinuation of treatment reduce the dosage gradually over a period of 1-2 wks
Prophylaxis of migraine headache [Non-FDA Approved]
- Start 20-40 mg/day PO
- Maintenance dose: 80-240 mg/day PO
Pediatric Dosing
- Safety and effectiveness in pediatric patients has not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 31-50 mL/min: Dosing interval q24-36 hrs
- 10-30 mL/min: Dosing interval q24-48 hrs
- <10 mL/min: Dosing interval q40-60 hrs
- Hemodialysis: Administer 40 mg as supplement
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Beta-blockade may inhibit sympathetic stimulation and it may precipitate more severe failure in patients with CHF
- Although this drug is contraindicated in overt congestive heart failure if essential use this drug with caution in patients with a history of failure who are well-compensated, usually with digitalis and diuretics
- Inotropic action of digitalis on heart muscle is not abolished by this drug
- Continuous use of beta blockers in patients without a history of heart failure may lead to cardiac failure. On first sign or symptom of heart failure digitalize the patient and/or treat them with diuretics and closely observe response or if possible gradually discontinue nadolol
- Abrupt discontinuation of such therapy may lead to exacerbation of angina and in some cases development of myocardial infarction [US Black Box Warning]
- Gradually reduce dose over a period of 1-2 wks and particularly carefully monitor patients with ischemic heart disease while discontinuing chronically administered nadolol. On marked worsening of angina or development of acute coronary insufficiency promptly reinstitute administration of this drug at least temporarily and undertake other appropriate measures for the management of unstable angina [US Black Box Warning]
- Warn patients against interruption or discontinuation of therapy without the physician's advice [US Black Box Warning]
- Avoid abrupt discontinuation of nadolol therapy even in patients treated only for hypertension as coronary artery disease is common and may be unrecognized [US Black Box Warning]
- Avoid therapy with beta-blockers in patients with bronchospastic diseases
- Withdraw therapy several days prior to surgery as it may increase the risks of general anesthesia and surgical procedures; if possible withdraw beta-blockers well before surgery takes place
- Inform anesthesiologist that the patient is on beta-blocker therapy in the event of emergency surgery
- Difficulty in restarting and maintaining the heart beat has also occurred in patients receiving therapy with beta-adrenergic blockers
- Therapy is associated with masking of premonitory signs and symptoms (e.g., tachycardia and blood pressure changes) of acute hypoglycemia. It is essential for adjusting the dose of antidiabetic drugs as beta-blockade also reduces the release of insulin in response to hyperglycemia
- This therapy may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Carefully manage patients suspected of developing thyrotoxicosis to avoid abrupt withdrawal of beta-adrenergic blockade as it might precipitate a thyroid storm
Cautions: Use cautiously in
- Renal impairment CrCl <50 mL/min (Dose reduction recommended)
- Hepatic impairment
- Geriatric patients (increased sensitivity to beta blockers; initial dosage reduction recommended)
- Pulmonary disease (including asthma)
- Diabetes mellitus (may mask signs of hypoglycemia)
- Thyrotoxicosis (may mask symptoms)
- Wolff-Parkinson-White Syndrome
- Peripheral vascular disease
- Bronchospastic disease
- Major surgery
- Pheochromocytoma
- Pregnancy 2nd or 3rd trimester
- Severe anaphylactic reaction
- Geriatrics
Pregnancy Category:C
Breastfeeding: Prefer other beta-adrenergic blockers especially while nursing a newborn or preterm infant as this drug is extensively excreted in breastmilk. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6 last accessed 31 May 2011). As per the manufacturer the potential for adverse effects in nursing infants exists and a decision should be made for discontinuing nursing or for discontinuing therapy taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Nadolol 20 MG TABS [Bottle] (MYLAN)
30 mg = $14.99
60 mg = $19.97 - Corgard 40 MG TABS [Bottle] (KING PHARMA)
30 mg = $110.98
90 mg = $310.96 - Nadolol 40 MG TABS [Bottle] (MYLAN)
30 mg = $16.99
90 mg = $29.97 - Corgard 80 MG TABS [Bottle] (KING PHARMA)
30 mg = $129.99
90 mg = $375.98 - Nadolol 80 MG TABS [Bottle] (MYLAN)
30 mg = $22.99
90 mg = $44.97 - Corgard 20 MG TABS [Bottle] (KING PHARMA)
30 mg = $93.99
90 mg = $265.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
