Classifications: beta-adrenergic antagonist (adrenergic blocking agent); antihypertensive; Therapeutic: antihypertensive; beta-adrenergic antagonist
Pregnancy Category: C
20 mg, 40 mg, 80 mg, 120 mg, 160 mg tablets
Nonselective beta-adrenergic blocking agent pharmacologically and chemically similar to propranolol. Inhibits response to
adrenergic stimuli by competitively blocking beta-adrenergic receptors within the heart. Reduces heart rate and cardiac
output at rest and during exercise, and also decreases conduction velocity through AV node and myocardial automaticity.
Decreases both systolic and diastolic BP at rest and during exercise. Suppression of beta2-adrenergic receptors in bronchial and vascular smooth muscle may cause bronchospasm and a Raynaud's-like phenomenon.
Hypertension, either alone or in combination with a diuretic. Also long-term prophylactic management of angina pectoris.
Bronchial asthma, severe COPD, inadequate myocardial function, sinus bradycardia, greater than first-degree conduction block,
overt cardiac failure, cardiogenic shock; pregnancy (category C). Safe use in children <18 y is not established.
CHF; diabetes mellitus; hyperthyroidism; renal failure, renal impairment.
Route & Dosage
Adult: PO 40 mg once/d, may increase up to 240320 mg/d in 12 divided doses
Note: Dose is usually titrated up in 4080 mg increments until optimum dose is achieved. Oral
- Do not discontinue abruptly; reduce dosage over a 12-wk period. Abrupt withdrawal can precipitate MI or thyroid storm
in susceptible patients.
- Store at 15°30° C (59°86° F); protect drug from light.
Adverse Effects (≥1%)Body as a Whole:
Hypersensitivity (rash, pruritus, laryngospasm, respiratory disturbances
). CV: Bradycardia, peripheral vascular insufficiency (Raynaud's type),
palpitation, postural hypotension, conduction or rhythm disturbances, CHF. GI:
Dry mouth. CNS: Dizziness, fatigue,
sedation, headache, paresthesias, behavioral changes. Special Senses:
Blurred vision, dry eyes. Skin:
Dry skin. Urogenital:
s may decrease hypotensive effects; may mask symptoms of a hypoglycemic reaction to insulin, sulfonylureas
; prazosin, terazosin
may increase severe hypotensive response to first dose.
3040% of PO dose absorbed. Peak:
24 h. Duration:
1724 h. Distribution:
Widely distributed; crosses placenta; distributed in breast milk. Elimination:
70% in urine; also in feces. Half-Life:
Assessment & Drug Effects
- Assess heart rate and BP before administration of each dose. Withhold drug and notify physician if apical pulse drops below
60 bpm or systolic BP below 90 mm Hg.
- Monitor weight. Advise patient to report weight gain of 11.5 kg (23 lb) in a day and any other possible signs
of CHF (e.g., cough, fatigue, dyspnea, rapid pulse, edema).
- Evaluate effectiveness for patients with angina by reduction in frequency of anginal attacks and improved exercise tolerance.
Improvement should coincide with steady state serum concentration reached within 69 d. Keep physician informed of
- Monitor patients with diabetes mellitus closely. Beta-adrenergic blockade produced by nadolol may prevent important clinical
manifestations of hypoglycemia (e.g., tachycardia, BP changes).
- Monitor I&O ratio and creatinine clearance in patients with impaired kidney function or with cardiac problems. Dosage intervals
will be lengthened with decreases in creatinine clearance.
Patient & Family Education
- Check pulse before taking each dose. Do not take your medication if pulse rate drops below 60 (or other parameter set by
physician) or becomes irregular. Consult your physician right away.
- Do not stop taking your medication or alter dosage without consulting your physician.
- Do not drive or engage in potentially hazardous activities until response to drug is known.