Class: Beta-adrenergic blocking agent
- Tablets 20 mg
- Tablets 40 mg
- Tablets 80 mg
- Tablets 160 mg
Blocks beta-receptors, which primarily affect CV system (decreases heart rate, contractility, and BP) and lungs (promotes bronchospasm).
Oral absorption is approximately 30%. T max is 3 to 4 h and steady state is 6 to 9 days.
Widely distributed into body tissues and into milk. Protein binding is approximately 30%.
Nadolol is eliminated unchanged primarily through kidneys. Plasma t 1/ 2 is 20 to 24 h; increases in renal failure.
Special PopulationsRenal Function Impairment
Indications and Usage
Management of hypertension and angina pectoris.
Hypersensitivity to beta-blockers; greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers or untreated hypotension; overt cardiac failure; sinus bradycardia; cardiogenic shock; bronchial asthma or bronchospasm, including severe COPD.
Dosage and AdministrationHypertension
PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments to desired response.Maintenance
PO 40 to 320 mg/day.Angina
PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments at 3- to 7-day intervals to desired response.Maintenance
PO 40 to 240 mg/day. Dosage intervals may need to be altered in patients with decreased renal function.
- Administer without regard to meals. Administer with food if GI upset occurs.
Store in tightly closed, light-resistant container at room temperature (59° to 86°F).
May enhance or reverse antihypertensive effect; potentially life-threatening situations may occur, especially on withdrawal.Epinephrine
Initial hypertensive episode followed by bradycardia may occur.Ergot derivatives
Peripheral ischemia, manifested by cold extremities and possible gangrene, may occur.Insulin
Prolonged hypoglycemia with masking of symptoms may occur.Lidocaine
Lidocaine levels may increase, leading to toxicity.NSAIDs
Some agents may impair antihypertensive effect.Prazosin
Orthostatic hypotension may be increased.Verapamil
Effects of both drugs may be increased.
Laboratory Test Interactions
Serum glucose may decrease; may interfere with glucose or insulin intolerance tests.
Bradycardia; hypotension; CHF; cold extremities; heart block; worsening angina; edema.
Depression; fatigue; lethargy; drowsiness; short-term memory loss; headache; dizziness.
Dry eyes; visual disturbances.
Nausea; vomiting; diarrhea.
Impotence; urinary retention; difficulty with urination.
May increase or decrease blood glucose; elevated triglycerides and total cholesterol; decreased HDL cholesterol.
Wheezing; bronchospasm; difficulty breathing.
Increased sensitivity to cold.
In patients with angina pectoris or coronary artery disease (CAD), abrupt withdrawal may cause exacerbation of angina, occurrence of MI and ventricular arrhythmias. Monitor patients closely. Because CAD is common and unrecognized, it may be prudent not to discontinue beta-blocker therapy abruptly in patients treated only for hypertension.
Category C .
Excreted in breast milk.
Safety and efficacy not established.
Reduced dosage advised in patients with renal impairment.
Reduced dosage advised in patients with hepatic impairment.
Beta-blocker withdrawal syndrome (eg, hypertension, tachycardia, anxiety, angina, MI) may occur 1 to 2 wk following sudden discontinuation of systemic beta-blocker therapy. Withdraw treatment gradually over 1 to 2 wk.
Deaths have occurred; aggressive therapy may be required.
Administer cautiously in CHF patients controlled by digitalis and diuretics. Notify health care provider at first sign or symptom of CHF or unexplained respiratory symptoms in any patient.
May mask signs and symptoms of hypoglycemia (eg, tachycardia, BP changes). May potentiate insulin-induced hypoglycemia.
Give drug with caution in patients with bronchospastic disease.
Peripheral vascular disease
May precipitate or aggravate symptoms of arterial insufficiency.
May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm.
Bradycardia, cardiogenic shock, intraventricular conduction disturbances, hypotension, AV block, depressed consciousness, CHF, asystole, coma.
- Teach patient how to measure pulse rate before taking medication. Explain that if pulse rate is less than 50 bpm, patient needs to discontinue taking medication immediately and notify health care provider.
- Ensure that patient has independently demonstrated how to measure pulse rate.
- Show patient how to monitor blood sugar levels, and explain that signs and symptoms of low blood sugar levels may be masked.
- Caution patient not to stop taking medication abruptly but to consult health care provider for instructions on safest way to discontinue medication.
- Instruct patient to report the following symptoms to health care provider: bradycardia, palpitations, dizziness, fatigue, insomnia or sleep disturbances, altered sensorium, GI symptoms, and changes in blood sugar levels.
- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
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