- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Oral formulations of nadolol.
Adjunct to treatment of hyperthyroidism
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.
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.
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Post operatively, nadolol dosage should be slowly reduced and then withdrawn following clinical stability.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
History of asthma
History of bronchospasm
Non-paced sinus node dysfunction
Second degree atrioventricular block
Severe peripheral circulatory disorder
Third degree atrioventricular block
Uncontrolled cardiac failure
Precautions and Warnings
Chronic obstructive pulmonary disease
First degree atrioventricular block
History of cardiac failure
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.
Elevation of liver enzymes
Exacerbation of psoriasis
Increased atrioventricular block
Localised and generalised rash
Peripheral vascular insufficiency
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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: December 2022
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
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Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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