nadolol

Contraindicated in:

Decompensated HF;
Pulmonary edema;
Cardiogenic shock;
Bradycardia or heart block;
Lactation: Lactation.

Use Cautiously in:

Renal impairment (CCr <50 mL/min);
Hepatic impairment;
Pulmonary disease (including asthma);
Diabetes mellitus (may mask signs of hypoglycemia);
Thyrotoxicosis (may mask symptoms);
Patients with a history of severe allergic reactions (intensity of reactions may be ↑);
OB: Crosses the placenta and may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have ↑ sensitivity to beta blockers; initial dose ↓ recommended.

Adv. Reactions/Side Effects ⬆ ⬇

CV: ARRHYTHMIAS, BRADYCARDIA, HF, orthostatic hypotension, peripheral vasoconstriction, PULMONARY EDEMA

Derm: itching, rash

EENT: blurred vision, dry eye, nasal stuffiness

Endo: hyperglycemia, hypoglycemia

GI: constipation, diarrhea, nausea

GU: erectile dysfunction, ↓libido

MS: arthralgia, back pain, muscle cramps

Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nightmares, paresthesia

Resp: bronchospasm, wheezing

Misc: drug-induced lupus syndrome

Interactions ⬆ ⬇

Drug-drug:

General anesthesia, IV phenytoin, diltiazem, and verapamil may cause additive myocardial depression.
Additive bradycardia may occur with digoxin.
Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates.
Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia).
Concurrent use with clonidine↑ hypotension and bradycardia.
Concurrent thyroid administration may ↓ effectiveness.
May alter the effectiveness of insulins or oral hypoglycemic agents (dosage adjustments may be necessary).
May ↓ the effectiveness of theophylline.
May ↓ the effects of dopamine or dobutamine.
Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension).
Concurrent NSAIDs may ↓ antihypertensive action.

Availability ⬆ ⬇

(Generic available)

Tablets: 20 mg; 40 mg; 80 mg; 160 mg

Route/Dosage ⬆ ⬇

PO (Adults ): Antianginal: 40 mg once daily initially; may ↑ by 40–80 mg/day every 3–7 days as needed (up to 240 mg/day). Antihypertensive: 40 mg once daily initially; may ↑ by 40–80 mg/day every 7 days as needed (up to 320 mg/day).

Renal Impairment

PO (Adults ): CCr 31–50 mL/min: ↑dosing interval to 24–36 hr; CCr 10–30 mL/min: ↑dosing interval to 24–48 hr; CCr <10 mL/min: ↑dosing interval to 40–60 hr.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Blocks stimulation of beta₁ (myocardial) and beta₂ (pulmonary, vascular, and uterine) receptor sites.

Therapeutic effects:

Decreased heart rate and BP.

Classifications ⬆ ⬇

Therapeutic Classification: antianginals, antihypertensives

Pharmacologic Classification: beta blockers

Pharmacokinetics ⬆ ⬇

Absorption: 30% absorbed after oral administration.

Distribution: Minimal penetration of the CNS.

Metabolism/Excretion: 70% excreted unchanged by the kidneys.

Half-Life: 10–24 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(anithypertensive effects)

ROUTE	ONSET	PEAK	DURATION
PO‡	up to 5 days	6–9 days	24 hr

‡With chronic dosing.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication exactly as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before next dose. Inform patient that abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia.
Advise patient to ensure that enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet for emergencies.
Teach patient and family how to check BP and HR. Instruct them to check HR daily and BP biweekly. Advise patient to hold dose and contact health care professional if HR <50 bpm or if BP changes significantly.
May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
Advise patients to make position changes slowly to minimize orthostatic hypotension, especially during initiation of therapy or with dose ↑.
Caution patient that this medication may ↑ sensitivity to cold.
Instruct patient to consult health care professional before taking any OTC medications, especially cold preparations, concurrently with this medication.
Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication may mask some signs of hypoglycemia, but dizziness and sweating may still occur.
Advise patient to notify health care professional if slow HR, difficulty breathing, wheezing, cold hands and feet, dizziness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
Instruct patient to inform health care professional of medication regimen before treatment or surgery.
Advise patient to carry identification describing disease process and medication regimen at all times.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Monitor neonates of women taking nadolol for symptoms of hypotension, bradycardia, hypoglycemia, and respiratory depression and manage accordingly. Monitor breastfed infants for bradycardia, dry mouth, skin or eyes, and diarrhea or constipation.
Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, smoking cessation). Medication controls but does not cure hypertension.
Angina: Caution patient to avoid overexertion.

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Indications ⬇

Contraind./Precautions ⬆ ⬇