Classifications: beta-adrenergic antagonist (adrenergic blocking agent); antihypertensive;
Therapeutic: antihypertensive
; beta-adrenergic antagonist
Prototype: Propranolol
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.

Therapeutic Effect

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.

Cautious Use

CHF; diabetes mellitus; hyperthyroidism; renal failure, renal impairment.

Route & Dosage

Hypertension, Angina
Adult: PO 40 mg once/d, may increase up to 240–320 mg/d in 1–2 divided doses


Note: Dose is usually titrated up in 40–80 mg increments until optimum dose is achieved.

  • Do not discontinue abruptly; reduce dosage over a 1–2-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: Impotence.


Drug: nsaids may decrease hypotensive effects; may mask symptoms of a hypoglycemic reaction to insulin, sulfonylureas; prazosin, terazosin may increase severe hypotensive response to first dose.


Absorption: 30–40% of PO dose absorbed. Peak: 2–4 h. Duration: 17–24 h. Distribution: Widely distributed; crosses placenta; distributed in breast milk. Elimination: 70% in urine; also in feces. Half-Life: 10–24 h.

Nursing Implications

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 1–1.5 kg (2–3 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 6–9 d. Keep physician informed of drug effect.
  • 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

© 2006-2023 Last Updated On: 01/27/2023 (0)
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