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Pharmacologic class: Beta-adrenergic blocker (nonselective)
Therapeutic class: Antianginal, antihypertensive
Pregnancy risk category C
FDA Box 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.
Blocks stimulation of beta1-and beta2-adrenergic receptor sites, decreasing cardiac output and thereby slowing heart rate and reducing blood pressure
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
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
• Renal impairment
• Migraine headache
• Parkinson's tremor
• 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)
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).
• Give with or without food.
• Be aware that drug may be given alone or with diuretic for hypertension.
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
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
• 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.
• 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.