Nadolol


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
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.
Dosage Details
Oral
Cardiac arrhythmias, Prophylaxis of migraine
Adult: 40-160 mg once daily.

Oral
Angina pectoris
Adult: Initially, 40 mg once daily, increased wkly up to 160 mg/day depending on response. Max: 240 mg/day.

Oral
Adjunct in hyperthyroidism
Adult: 80-160 mg once daily. May require higher doses depending on patient's response.

Oral
Hypertension
Adult: Initially, 40-80 mg once daily, increased wkly to ≥240 mg/day according to response.
Elderly: Initially, 20 mg/day. Titrate according to response.
Renal Impairment
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.
Administration
May be taken with or without food.
Contraindications
AV block (2nd and 3rd degree), sinus bradycardia, bronchial asthma, cardiogenic shock, or overt cardiac failure.
Special Precautions
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.
Adverse Reactions
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.
MonitoringParameters
Monitor heart rate and BP. Carefully monitor signs/symptoms of angina exacerbation when discontinuing therapy.
Overdosage
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.
Drug Interactions
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.
Action
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.
Storage
Store between 15-30°C. Avoid excessive heat. Protect from light.
MIMS Class
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 © 2020 MIMS. All rights reserved. Powered by MIMS.com
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