Nadolol oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of nadolol.
Drugs List
Therapeutic Indications
Uses
Adjunct to treatment of hyperthyroidism
Angina pectoris
Migraine (prophylaxis)
Preparation for thyroidectomy
Treatment of cardiac tachyarrhythmias
Treatment of essential hypertension
Dosage
Dosage should be titrated gradually with at least a week between increments to assess patient response which may vary considerably.
Adults
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.
Hypertension
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.
Migraine
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.
Hyperthyroidism
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Post operatively, nadolol dosage should be slowly reduced and then withdrawn following clinical stability.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.
Contraindications
Children under 18 years
Asthma
Breastfeeding
Cardiac failure secondary to pulmonary disorder
Cardiogenic shock
History of asthma
History of bronchospasm
Hypotension
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
Elderly
General anaesthesia
Chronic obstructive pulmonary disease
Diabetes mellitus
First degree atrioventricular block
Hepatic impairment
History of cardiac failure
Myasthenia gravis
Phaeochromocytoma
Portal hypertension
Pregnancy
Psoriasis
Renal impairment - eGFR below 50ml/ minute/ 1.73m squared
Thyrotoxicosis
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
Pregnancy
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).
Lactation
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
Agranulocytosis
Alopecia
Anorexia
Arterial thrombosis
Behavioural disturbances
Bloating
Blurred vision
Bradycardia
Bronchospasm
Cardiac failure
Catatonia
Cold extremities
Conduction disturbances
Constipation
Cough
Depression
Diarrhoea
Disorientation
Dizziness
Dry eyes
Dry mouth
Dry skin
Dyspnoea
Elevation of liver enzymes
Emotional lability
Exacerbation of psoriasis
Facial swelling
Fatigue
Fever
Flatulence
Hallucinations
Headache
Heart block
Hypoglycaemia
Hypotension
Impaired memory
Impotence
Increased atrioventricular block
Indigestion
Insomnia
Ischaemic colitis
Light-headedness
Localised and generalised rash
Nasal stuffiness
Nausea
Paraesthesia
Pemphigoid reaction
Peripheral vascular insufficiency
Peyronie's disease
Pruritus
Psychosis
Purpura
Raynaud's syndrome
Reduced libido
Sedation
Sleep disturbances
Slurred speech
Sweating
Thrombocytopenic purpura
Tinnitus
Vertigo
Visual disturbances
Vomiting
Weight gain
Effects on Laboratory Tests
Beta blockers, such as nadolol, significantly affect the accuracy of stress tests of all types.
Overdosage
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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
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: www.nice.org.uk Last accessed: 08 December 2022
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Nadolol. Last revised: 23 February 2021
Last accessed: 08 December 2022
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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