Nadolol

Listed in Dosage.

Adult : PO HTN Initial: 40-80 mg once daily. Increased to ≥240 mg/day according to response. Angina pectoris Initial: 40 mg once daily; increased wkly up to 160 mg/day depending on response. Max: 240 mg/day. Cardiac arrhythmias; Migraine prophylaxis 40-160 mg once daily. Adjunct in the treatment of hyperthyroidism 80-160 mg once daily. May require higher dose depending on patient's response.

Oral
Cardiac arrhythmias, Prophylaxis of migraine

Oral
Angina pectoris

Oral
Adjunct in hyperthyroidism

Oral
Hypertension

HTN, Angina pectoris:
May require lower dose or less frequent admin.

CrCl	Dosage
<10	Given every 40-60 hr.
10-30	Given every 24-48 hr.
31-50	Given every 24-36 hr.

May be taken with or without food.

AV block (2nd and 3rd degree), sinus bradycardia, bronchial asthma, cardiogenic shock, or overt cardiac failure.

Inadequate cardiac function, latent cardiac insufficiency, well-compensated heart failure, nonallergic bronchospasm, DM, myasthenia gravis, peripheral vascular disease including Raynaud's disease. Patients undergoing surgery involving general anaesth. Renal or hepatic impairment. May mask signs and symptoms of hyperthyroidism and acute hypoglycaemia. Avoid abrupt withdrawal as it may precipitate thyroid storm, exacerbate angina, HTN and MI. Pregnancy and lactation.

Dizziness, fatigue, hallucinations, mental depression, sedation, headache, paraesthesia, malaise, insomnia, sleep disturbances. Bradycardia, peripheral vascular insufficiency, GI disturbances (e.g. diarrhoea, nausea, vomiting). Bronchospasm, rash, pruritus, reversible alopecia, slurred speech, dry mouth, eyes and skin, facial swelling, wt gain, impotence, nasal stuffiness, tinnitus, cough, blurred vision, weakness, sweating, numbness and atypical behaviour.

PO: C

Monitor heart rate and BP. Carefully monitor signs/symptoms of angina exacerbation when discontinuing therapy.

Symptoms: Hypotension, bradycardia, bronchospasm, acute cardiac failure. Management: If ingestion is recent, emesis should be induced. Endotracheal intubation followed by gastric lavage w/ activated charcoal should be performed if patient is comatose, having seizures or lacks gag reflex. IV atropine sulfate may be given for excessive bradycardia, and if it persists, IV isoproterenol HCl may be administered cautiously. For hypotension, a vasopressor (e.g. dobutamine, dopamine, epinephrine, norepinephrine) may be given cautiously, and for bronchospasm, a β₂-adrenergic agonist and/or IV aminophylline. An IV cardiac glycoside and diuretic may be used for cardiac failure. IV glucagon may also be useful. Haemodialysis may be beneficial in severe cases.

Antagonises β-adrenergic stimulating effects of sympathomimetic agents (e.g. isoproterenol). Additive hypotensive effects w/ diuretics or other hypotensive drugs, phenothiazines, reserpine. Additive negative effects on SA or AV nodal conduction w/ cardiac glycosides, nondihydropyridine Ca channel blockers. May potentiate and prolong the effects of neuromuscular blockers (e.g. tubocurarine Cl). Reduced antihypertensive effects w/ NSAIDs.

Description: Nadolol is a non-cardioselective β-blocker. It lacks intrinsic sympathomimetic and membrane-stabilising activity.
Duration: 17-24 hr.
Pharmacokinetics:
Absorption: Incompletely absorbed from the GI tract. Time to peak plasma concentration: Approx 3 or 4 hr.
Distribution: Widely distributed and enters breast milk. Volume of distribution: Approx 2 L/kg. Plasma protein binding: Approx 30%.
Metabolism: Not metabolised.
Excretion: Via urine (as unchanged drug). Plasma half-life: Approx 12-24 hr.

Store between 15-30°C. Avoid excessive heat. Protect from light.

Beta-Blockers

Anon. Nadolol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 26/11/2013.

Buckingham R (ed). Nadolol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com . Accessed 26/11/2013.

Corgard Tablets. U.S. FDA. https://www.fda.gov/. Accessed 26/11/2013.

McEvoy GK, Snow EK, Miller J et al (eds). Nadolol. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 26/11/2013.

Wickersham RM. Nadolol. Facts and Comparisons [online]. St. Louis, MO. Wolters Kluwer Clinical Drug Information, Inc. https://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed 26/11/2013.