Nadolol


Generic Medicine Info
Indications and Dosage
Oral
Angina pectoris
Adult: Initially, 40 mg once daily. Doses may be increased gradually at weekly intervals until an adequate response is achieved. Usual maintenance dose: 40 mg or 80 mg once daily. Max: 160 mg or 240 mg once daily.
Elderly: Initiate at the lower end of the dosing range.

Oral
Cardiac arrhythmias
Adult: Initially, 40 mg once daily. Doses may be increased to 160 mg once daily if needed. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Elderly: Initiate at the lower end of the dosing range.

Oral
Hypertension
Adult: Initially, 40-80 mg once daily. Doses may be increased weekly by 40-80 mg increments according to response. Max: 240 mg or 320 mg once daily.
Elderly: Initiate at the lower end of the dosing range.

Oral
Prophylaxis of migraine
Adult: Initially, 40 mg once daily. Doses may be increased gradually in 40 mg increments according to response. Usual maintenance dose: 80-160 mg once daily. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Elderly: Initiate at the lower end of the dosing range.

Oral
Hyperthyroidism
Adult: As an adjunct to conventional therapy: 80-160 mg once daily. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Elderly: Initiate at the lower end of the dosing range.
Renal Impairment
Dose adjustment may be required.
Administration
May be taken with or without food.
Contraindications
Bronchial asthma or history of asthma, sinus bradycardia, heart block greater than 1st degree, cardiogenic shock, right ventricular failure secondary to pulmonary hypertension, overt cardiac failure.
Special Precautions
Patient with compensated heart failure, history of severe anaphylaxis to allergens, conduction abnormality (e.g. sick sinus syndrome), diabetes mellitus, myasthenia gravis, peripheral vascular disease, Raynaud's disease, untreated phaeochromocytoma. Not for use in patients with bronchospastic disease. Patient undergoing surgery. Avoid abrupt withdrawal. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Hypersensitivity to catecholamines (following treatment withdrawal); exacerbation of angina, hypertension, MI (following abrupt withdrawal); ocular changes (e.g. conjunctivitis and dry eye); induced thyroid storm (following abrupt withdrawal in thyroid patients), mask signs of hyperthyroidism; cardiac failure; may potentiate hypoglycaemia and/or mask signs and symptoms; induction or exacerbation of psoriasis.
Cardiac disorders: Bradycardia, rhythm or conduction disturbances, palpitation.
General disorders and administration site conditions: Fatigue, cold extremities, oedema.
Nervous system disorders: Dizziness, drowsiness.
Psychiatric disorders: Insomnia.
Vascular disorders: Hypotension, symptoms of peripheral vascular insufficiency (usually of Raynaud's type).
Monitoring Parameters
Monitor heart rate, blood pressure; signs and symptoms of exacerbation of angina (when discontinued).
Overdosage
Symptoms: Excessive bradycardia, cardiac failure, hypotension, bronchospasm, transitory increase in BUN, serum electrolyte changes. Management: Symptomatic and supportive treatment. Perform gastric lavage or haemodialysis. Administer atropine (0.25-1 mg) for excessive bradycardia; if no response to vagal blockade, administer isoprenaline cautiously. Administer digitalis glycoside and diuretic for cardiac failure; glucagon may also be useful. Administer fluid for hypotension but if ineffective, give vasopressors (e.g. dopamine, epinephrine, dobutamine). Administer β2-agonists and/or theophylline derivative for bronchospasm.
Drug Interactions
May increase the risk of protracted severe hypotension with myocardial depressants (e.g. lidocaine, procainamide) and general anaesthetics that cause myocardial depression (e.g. chloroform, cyclopropane, trichloroethylene, ether). Reversed hypotensive effects and increased vasoconstrictor activity with β-adrenoreceptor stimulants (e.g. isoprenaline, verapamil, norepinephrine, epinephrine). Additive effects with catecholamine-depleting drugs, antihypertensives, phenothiazine, haloperidol, ergot alkaloids. May increase the risk of bradycardia with MAOIs, fingolimod. Potentiated effects with Ca channel blockers. May increase the risk of depression with diltiazem. May cause additive or antagonistic effects with other antiarrhythmics. May increase serum concentration of lidocaine. May have reduced antihypertensive effects with indometacin and other NSAIDs.
Lab Interference
Significantly affects the accuracy of all types of stress tests.
Action
Description: Nadolol is a non-selective β-adrenergic blocker that competitively blocks response to β1- and β2-adrenergic stimulation. It decreases portal pressure by producing splanchnic vasoconstriction thereby reducing portal blood flow. Additionally, it does not exhibit any membrane stabilising or intrinsic sympathomimetic activity.
Duration: 17-24 hours.
Pharmacokinetics:
Absorption: Incompletely absorbed from the gastrointestinal tract. Time to peak plasma concentration: Approx 3-4 hours.
Distribution: Widely distributed. Enters the breast milk. Volume of distribution: Approx 2 L/kg. Plasma protein binding: Approx 30%.
Metabolism: Not metabolised.
Excretion: Via urine (as unchanged drug). Elimination half-life: 20-24 hours.
Chemical Structure

Chemical Structure Image
Nadolol

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 39147, Nadolol. https://pubchem.ncbi.nlm.nih.gov/compound/39147. Accessed July 26, 2022.

Storage
Store below 25°C. Protect from light.
MIMS Class
Beta-Blockers
ATC Classification
C07AA12 - nadolol ; Belongs to the class of non-selective beta-blocking agents. Used in the treatment of cardiovascular diseases.
References
Anon. Nadolol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 09/06/2022.

Apotex NZ Ltd. Apo-Nadolol 40 mg and 80 mg Tablets data sheet 16 June 2017. Medsafe. http://www.medsafe.govt.nz. Accessed 09/06/2022.

Buckingham R (ed). Nadolol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/06/2022.

Corgard Tablet (USWM, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 09/06/2022.

Joint Formulary Committee. Nadolol. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/06/2022.

Nadolol 80 mg Tablets (Neon Healthcare Ltd). MHRA. https://products.mhra.gov.uk. Accessed 09/06/2022.

Disclaimer: This information is independently developed by MIMS based on Nadolol from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2024 MIMS. All rights reserved. Powered by MIMS.com
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