Nadolol

Nadolol is a beta-blocker used to treat angina (chest pain) and hypertension (high blood pressure).

Nadolol is available under the following different brand names: Corgard.

Dosage Forms and Strengths

Tablet

• 20 mg
• 40 mg
• 80 mg

Dosage Considerations – Should be Given as Follows:

Hypertension

• Adult: 40-320 mg orally once/day
• Geriatric: 20-320 mg orally once/day

Angina Pectoris

• Adult: Initial 40 mg/day orally, increase gradually every 3-7 days
• Doses up to 160-240mg once/day may be needed
• Geriatric: Initial 20 mg/day orally, increase gradually every 3-7 days
• Doses up to 160-240mg once/day may be needed

Supraventricular Tachycardia (SVT), Maintenance (Off-label)

• 60-160 mg/day orally

Aggressive Behavior; Upper GI Rebleed (Off-label)

• 40-160 mg/day orally

Migraine, Prophylaxis (Off-label)

• 40-80 mg orally once/day (up to 240 mg/day)

Mastalgia (Off-label)

• 10 mg orally once/day for 4 months

Renal Impairment

• CrCl greater than 50 mL/min: Give once/day
• CrCl 31-50 mL/min: Give every 24-36 hours
• CrCl 10-30 mL/min: Give every 24-48 hours
• CrCl less than 10 mL/min: Give every 40-60 hours

Hepatic Impairment

• Dose adjustments not necessary

Additional Information

• Less effective than thiazide diuretics in black and geriatric patients
• Shown to decrease mortality in hypertension and post-myocardial infarction
• Not approved for pediatric use

Other Indications and Uses

• Off-label: Irregular heartbeats (arrhythmias), gastrointestinal (GI) bleed, hyperthyroidism, reduce intraocular pressure (IOP), supraventricular tachycardia (SVT)

Common side effects or health problems may include:

• Drowsiness
• Insomnia
• Decreased sexual ability
• Slow heart rate
• Dizziness
• Fatigue
• Low blood pressure (hypotension)
• Weakness
• Spinning Sensation (vertigo)
• Tired Feeling
• Bloating
• Gas
• Tingly Feeling

Less common side effects of nadolol include:

• Abdominal discomfort/upset stomach
• Constipation
• Diarrhea
• Nausea
• Cough
• Nasal congestion

Other side effects of nadolol include:

• Bronchospasm, depression, decreased exercise tolerance, Raynaud's phenomenon
• May increase triglyceride levels and insulin resistance, and decrease HDL levels

Rare but serious side effects of nadolol include:

• Bluish color of the fingers/toes/nails
• Hair loss (reversible)
• Mental/mood changes (e.g., depression, confusion, memory problems)
• Decreased sexual ability
• Swelling of the ankles or feet
• Severe tiredness
• Vision changes
• Wheezing
• Unexplained or sudden weight gain

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of this medicine or any drug before seeking medical advice from your doctor, healthcare provider or pharmacist first. To do so may result in serious consequences or side effects.

• Nadolol has no known severe interactions with other drugs.
• Nadolol has serious interactions with at least 24 different drugs.
• Nadolol has moderate interactions with at least 206 different drugs.
• Nadolol has mild interactions with at least 30 different drugs.

This document does not contain all possible interactions from the use of this medication. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

• May exacerbate ischemic heart disease following abrupt withdrawal.
• Hypersensitivity to catecholamines has been observed during withdrawal.
• Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuation.
• When discontinuing chronically administered beta-blockers (particularly with ischemic heart disease) gradually reduce dose over 1-2 weeks and carefully monitor.
• If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina).
• Warn patients against interruption or discontinuation of beta-blocker without physician advice.
• Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension.
• This medication contains nadolol. Do not take Corgard if you are allergic to nadolol or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity
• Overt cardiac failure, 2°/3° heart block, cardiogenic shock
• Asthma/chronic obstructive pulmonary disease (COPD)
• Avoid during breastfeeding
• Sinus bradycardia
• Sick sinus syndrome without permanent pacemaker

Effects of Drug Abuse

• No information provided

Short-Term Effects

• See "What Are Side Effects Associated with Using Nadolol?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Nadolol?"

Cautions

• Anesthesia/surgery (myocardial depression); chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
• Nonallergenic bronchospasm, cerebrovascular insufficiency, well-compensated congestive heart failure (CHF), diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease.
• Sudden discontinuation can exacerbate angina and lead to myocardial infarction.
• Increased risk of stroke after surgery.
• Use in pheochromocytoma.

Pregnancy and Lactation

• Use nadolol with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
• Nadolol is concentrated in breast milk. Use with caution if breastfeeding. The American Academy of Pediatrics (AAP) Committee states nadolol is compatible with nursing.