nadolol

nadolol /na·do·lol/ (na-do´lol) a nonselective β used for the treatment of angina pectoris and hypertension.

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na·do·lol (n-dll)

n.

A beta-blocker drug used primarily to treat angina pectoris.

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nadolol

[nad′ənol]

a beta-adrenergic blocking agent.

indications It is prescribed for long-term management of angina pectoris, for hypertension, and for migraine prophylaxis.

contraindications Bronchial asthma, sinus bradycardia, greater than first-degree conduction block, cardiogenic shock, overt cardiac failure, or known hypersensitivity to this drug prohibits its use.

adverse effects Among the more serious adverse effects are bronchospasm, bradycardia, precipitation of heart failure, cardiac arrhythmia, masking of signs of hypoglycemia in diabetics, fatigue, and lethargy. GI disturbances, rashes, and other allergic reactions may also occur.

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nadolol (nadō´lol),

n brand name: Corgard;
drug class: nonselective β-adrenergic blocker;
action: competitively blocks stimulation of β-adrenergic receptors within the heart; produces negative chronotropic and inotropic activity, slows conduction of AV node, decreases heart rate, which decreases oxygen consumption in myocardium; also decreases activity of the renin-aldosterone-angiotensin system;
uses: chronic stable angina pectoris, mild to moderate hypertension.

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nadolol

an adrenergic blocking agent that affects both β₁- and β₂-receptors.

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nadolol

Apo-Nadolol (CA), Corgard, Novo-Nadolol (CA), Syn-Nadolol (CA)

Pharmacologic class: Beta-adrenergic blocker (nonselective)

Therapeutic class: Antianginal, antihypertensive

Pregnancy risk category C

FDA Boxed Warning

• Catecholamine hypersensitivity may occur after drug withdrawal. Angina exacerbation and in some cases, myocardial infarction have followed abrupt withdrawal. When discontinuing long-term nadolol, reduce dosage gradually over 1 to 2 weeks and monitor patient carefully. If angina worsens markedly or acute coronary insufficiency develops, reinstate drug promptly and take other appropriate measures to manage angina. Caution patient not to interrupt or stop therapy without physician's advice. Because coronary artery disease is common and may be unrecognized, don't discontinue drug abruptly, even in patients treated only for hypertension.

Action

Blocks stimulation of beta₁- and beta₂-adrenergic receptor sites, decreasing cardiac output and thereby slowing heart rate and reducing blood pressure

Availability

Tablets: 20 mg, 40 mg, 80 mg, 120 mg, 160 mg

⊘Indications and dosages

➣ Angina pectoris

Adults: Initially, 40 mg P.O. daily; may increase by 40 to 80 mg q 3 to 7 days p.r.n., up to a maximum of 240 mg/day

➣ Hypertension

Adults: Initially, 40 mg P.O. daily; may increase by 40 to 80 mg q 7 days p.r.n., up to 320 mg/day

Dosage adjustment

• Renal impairment

Off-label uses

• Hyperthyroidism
• Migraine headache
• Parkinson's tremor

Contraindications

• Hypersensitivity to drug or other beta-adrenergic blockers
• Pulmonary edema or cardiogenic shock
• Sinus bradycardia or heart block
• Heart failure (unless secondary to tachyarrhythmia treatable with beta blockers)
• Bronchial asthma (including severe chronic obstructive pulmonary disease)

Precautions

Use cautiously in:
• renal or hepatic impairment, pulmonary disease, diabetes mellitus, thyrotoxicosis
• history of severe allergic reactions
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give with or without food.
• Be aware that drug may be given alone or with diuretic for hypertension.

Route	Onset	Peak	Duration
P.O.	5 days	3-4 hr	24 hr

Adverse reactions

CNS: dizziness, fatigue, paresthesia, behavior changes, sedation

CV: bradycardia, peripheral vascular insufficiency (Raynaud's phenomenon), heart failure

EENT: blurred vision, dry eyes, nasal congestion

GI: nausea, constipation, diarrhea, abdominal discomfort or bloating, indigestion, anorexia

Respiratory: bronchospasm

Skin: rash

Interactions

Drug-drug. Amphetamines, ephedrine, epinephrine, norepinephrine, phenylephrine, pseudoephedrine: severe vasoconstriction and bradycardia

Antihypertensives, nitrates: additive hypotension

Clonidine: increased hypotension and bradycardia

Digoxin: additive bradycardia

Diltiazem, general anesthestics, phenytoin (I.V.), verapamil: additive myocardial depression

Insulins, oral hypoglycemics: altered glycemic control

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive action

Thyroid hormones: decreased nadolol efficacy

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Cocaine use: severe vasoconstriction, bradycardia

Patient monitoring

• Monitor vital signs and peripheral circulation. Notify prescriber of heart rate below 55 beats/minute.
• Assess for signs and symptoms of heart failure or bronchospasm.

Patient teaching

• Advise patient to take drug with meals and a bedtime snack to minimize GI upset.
• Teach patient how to measure pulse and blood pressure; tell him when to notify prescriber.
• Instruct patient to avoid over-the-counter products containing stimulants, such as some cold and flu remedies and nasal decongestants.
• Tell diabetic patient and family that drug may mask hypoglycemia symptoms. Advise patient to monitor urine or blood glucose regularly.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.