nadolol


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nadolol

 [na-do´lol]
a beta-adrenergic blocking agent that affects both β1- and β2-receptors; administered orally as an antihypertensive agent and for treatment of angina pectoris.

nadolol

Apo-Nadolol, Corgard, Novo-Nadolol

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.

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.

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.

nadolol

(nā-dō′lōl)
n.
A beta-blocker drug, C17H27NO4, used to treat hypertension and angina pectoris.

nadolol

A non-selective beta-blocker drug that acts on all beta-adrenergic receptor sites. A brand name is Corgard.
References in periodicals archive ?
As appearing from the loadings in Figure 2(b), (1) basic drugs, terfenadine, toremifene, nadolol, carvedilol, and haloperidol, and (2) acidic drugs, diclofenac and etodolac, have a big weight on PC1 and PC2, respectively, in comparison to the other drugs, which indicate that they play a main role in column classification.
Like other drugs, the patient leaflet accompanying nadolol tablets warns that certain medicines, including herbal remedies, can interact with their action.
In the new study, ten healthy men and women took 30 mg of nadolol daily for two weeks, after drinking either three cups of green tea or water.
The patient refused topical steroid therapy and continued Nadolol for portal hypertension.
Nevertheless, different studies [12, 13, 31] show a high photoability of some [beta]-blockers, for example, propranolol, nadolol, and alprenolol.
Beneficial effect of nadolol on anxiety-induced disturbances of performance in musicians: A comparison with diazepam and placebo.
In the present study, we investigated effects of green tea extract (GTE) and (--)-epigallocatechin-3-gallate (EGCG) on pharmacokinetics of a non-selective hydrophilic 13-blocker nadolol, which is reported to be a substrate for several drug transporters and is not metabolized by cytochrome P450 enzymes.
nadolol in the prevention of first variceal bleeding in patients with cirrhosis.
Some commonly prescribed drugs in this class include atenolol (Tenormin), betaxolol (Kerlone), bisoprolol (Zebeta), carteolol (Cartrol), acebutolol (Sectral), metoprolol (Lopressor, Toprol-XL), nadolol (Corgard), propranolol (Inderal), sotolol (Betapace) and timolol (Blocadren).
First-line therapy is a long-acting beta-blocker such as nadolol, coupled with exercise restriction.
Beta-blockers including metoprolol, propranolol, timolol, atenolol, and nadolol also have been found effective for migraine headache prevention.
The bioavailability of oral applied anticancer drugs, for example, imatinib, and drugs given frequently to cancer patients, like deltorphin II and nadolol, could be influenced by the induction of intestinal OATP1A2 [42].