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Nadolol oral


Oral formulations of nadolol.

Drugs List

  • nadolol 80mg tablets
  • Therapeutic Indications


    Adjunct to treatment of hyperthyroidism
    Angina pectoris
    Migraine (prophylaxis)
    Preparation for thyroidectomy
    Treatment of cardiac tachyarrhythmias
    Treatment of essential hypertension


    Dosage should be titrated gradually with at least a week between increments to assess patient response which may vary considerably.


    Angina pectoris
    Initially 40mg once daily, increasing at weekly intervals until adequate response obtained or excessive bradycardia occurs. Most patients respond to 160mg or less daily. Safety and value of doses over 240mg daily not established.

    Initially 80mg once daily, increasing by a weekly increment of 80mg or less until optimum response obtained. Usual dose range 80mg to 240mg daily, but higher doses have been required for some patients.
    In some patients addition of a diuretic, peripheral vasodilator and/or other antihypertensive may be necessary to achieve satisfactory response.

    Treatment of hypertension associated with phaeochromocytoma may require addition of an alpha blocker.

    Cardiac tachyarrhythmias
    Initially 40mg once daily increasing if necessary to 160mg once daily.
    If bradycardia occurs reduce dose to 40mg once daily.

    Initially 40mg once daily, increasing gradually in 40mg increments until optimum migraine prophylaxis achieved.
    Usual maintenance dose is 80mg to 160mg once daily. If no satisfactory response after 4 to 6 weeks at maximum dose, withdraw drug gradually.

    Dosage range is 80mg to 160mg once daily, usually 160mg once daily.
    Nadolol may be given with conventional anti-thyroid treatment.

    Preparation for a partial thyroidectomy
    Administer nadolol in conjunction with potassium iodide for 10 days prior to operation.
    Nadolol should be administered on the morning of the operation.
    Post operatively, nadolol dosage should be slowly reduced and then withdrawn following clinical stability.

    Patients with Renal Impairment

    Dosage interval should be increased when eGFR is below 50ml/minute/1.73m squared.


    Children under 18 years
    Cardiac failure secondary to pulmonary disorder
    Cardiogenic shock
    History of asthma
    History of bronchospasm
    Metabolic acidosis
    Non-paced sinus node dysfunction
    Prinzmetal's angina
    Second degree atrioventricular block
    Severe peripheral circulatory disorder
    Sinus bradycardia
    Third degree atrioventricular block
    Uncontrolled cardiac failure

    Precautions and Warnings

    Allergic disposition
    General anaesthesia
    Chronic obstructive pulmonary disease
    Diabetes mellitus
    First degree atrioventricular block
    Hepatic impairment
    History of cardiac failure
    Myasthenia gravis
    Portal hypertension
    Renal impairment - eGFR below 50ml/ minute/ 1.73m squared

    Advise diabetic patients that hypoglycaemic symptoms may be reduced/altered
    Anaesthetist should be made aware patient is taking this medication
    Give in conjunction with alpha blocker in patients with phaeochromocytoma
    May mask symptoms of hyperthyroidism
    May unmask the symptoms of myasthenia gravis
    Modify the dose interval if eGFR is below 50ml/ minute/ 1.73m squared
    Advise ability to drive/operate machinery may be affected by side effects
    Use in conjunction with potassium iodide for 10 days before thyroidectomy
    Monitor blood glucose closely in patients with diabetes mellitus
    Monitor lung function in patients with respiratory disorders
    Monitor patients during drug withdrawal esp. in ischaemic heart disease
    Monitor patients for signs and symptoms of cardiac failure
    Beta blockers may reduce the response to adrenaline in anaphylaxis
    Drug induced bronchospasm may occur
    May exacerbate psoriasis
    May increase sensitivity to allergens
    May affect results of some laboratory tests
    Abrupt withdrawal in thyroid patients can precipitate thyroid storm
    Abrupt withdrawal may be associated with exacerbation of angina
    Discuss discontinuation prior to surgery
    Do not withdraw this drug suddenly
    Withdraw gradually over at least 2 weeks
    Discontinue if worsening symptoms of cardiac failure develop
    Possibly withdraw treatment if dry eyes and/or skin rash occur
    Consider reducing initial dose in the elderly
    Advise patient not to take NSAIDs unless advised by clinician
    Advise patients to avoid green tea and green tea products

    Do not withdraw this drug suddenly but do so over at least 2 weeks as abrupt withdrawal may be associated with exacerbation of angina, hypersensitivity to catecholamines, hypertension, and in some cases myocardial infarction.

    Nadolol occasionally causes hypoglycaemia, even in non-diabetic patients e.g. neonates, infants, children, elderly patients, patients on haemodialysis or patients suffering from chronic liver disease and patients suffering from overdose. Severe hypoglycaemia associated with nadolol has rarely presented with seizures and/or coma in isolated patients.

    Nadolol may produce hypotension and/or bradycardia which may result in vertigo, syncope or orthostatic hypotension.

    Pregnancy and Lactation


    Use nadolol with caution during pregnancy.

    The manufacturer does not recommend using nadolol during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus. At the time of writing, there is limited published information regarding the use of nadolol during pregnancy in humans. However, foetal growth retardation has been reported. Neonates have exhibited bradycardia, hypoglycaemia, respiratory distress and associated symptoms as a result of the mother receiving nadolol at parturition.

    Beta blockers reduce placental perfusion, which may result in intrauterine foetal death, immature and premature deliveries. Intrauterine growth retardation (IUGR), and reduced placental weight may be caused by nadolol. The greatest weight reductions are seen when treatment begins in the second trimester (Briggs, 2015).


    Nadolol is contraindicated during breastfeeding.

    The manufacturer advises that the patient either discontinues nadolol or discontinues breastfeeding. Available data indicates nadolol is expressed in human breast milk. Because of its extensive excretion into human breast milk and its renal excretion, other beta-blockers are preferred, especially while nursing a newborn or preterm infant (LactMed, 2021). Effects on exposed infants are unknown.

    Side Effects

    Abdominal discomfort
    Arterial thrombosis
    Behavioural disturbances
    Blurred vision
    Cardiac failure
    Cold extremities
    Conduction disturbances
    Dry eyes
    Dry mouth
    Dry skin
    Elevation of liver enzymes
    Emotional lability
    Exacerbation of psoriasis
    Facial swelling
    Heart block
    Impaired memory
    Increased atrioventricular block
    Ischaemic colitis
    Localised and generalised rash
    Nasal stuffiness
    Pemphigoid reaction
    Peripheral vascular insufficiency
    Peyronie's disease
    Raynaud's syndrome
    Reduced libido
    Sleep disturbances
    Slurred speech
    Thrombocytopenic purpura
    Visual disturbances
    Weight gain

    Effects on Laboratory Tests

    Beta blockers, such as nadolol, significantly affect the accuracy of stress tests of all types.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: December 2022

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Nadolol 80mg Tablets. Neon Healthcare Ltd. Revised January 2022.

    NICE Evidence Services Available at: Last accessed: 08 December 2022

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Nadolol. Last revised: 23 February 2021
    Last accessed: 08 December 2022

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.