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All about: Nadolol

Big Image Pronouncation: (nay-DOE-lahl)
Class: Beta-adrenergic blocking agent

Trade Names:
Corgard
- Tablets 20 mg
- Tablets 40 mg
- Tablets 80 mg

Trade Names:
Nadolol
- Tablets 160 mg

Apo-Nadol (Canada)
Novo-Nadolol (Canada)

Mechanism of Action

Pharmacology

Blocks beta-receptors, which primarily affect CV system (decreases heart rate, contractility, and BP) and lungs (promotes bronchospasm).

Pharmacokinetics

Absorption

Oral absorption is approximately 30%. T max is 3 to 4 hr and steady state is 6 to 9 days.

Distribution

Widely distributed into body tissues and into milk. Protein binding is approximately 30%.

Metabolism

Not metabolized.

Elimination

Nadolol is eliminated unchanged primarily through kidneys. Plasma t 1/ 2 is 20 to 24 hr; increases in renal failure.

Special Populations

Renal Function Impairment

Half-life increases.

Indications and Usage

Management of hypertension and angina pectoris.

Contraindications

Hypersensitivity to beta-blockers; greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers or untreated hypotension; overt cardiac failure; sinus bradycardia; cardiogenic shock; bronchial asthma or bronchospasm, including severe COPD.

Dosage and Administration

Hypertension
Adults

PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments to desired response.

Maintenance

PO 40 to 320 mg/day.

Angina
Adults

PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments at 3- to 7-day intervals to desired response.

Maintenance

PO 40 to 240 mg/day. Dosage intervals may need to be altered in patients with decreased renal function.

General Advice

  • Administer without regard to meals. Administer with food if GI upset occurs.

Storage/Stability

Store in tightly closed, light-resistant container at room temperature (59° to 86°F).

Drug Interactions

Clonidine

May enhance or reverse antihypertensive effect; potentially life-threatening situations may occur, especially on withdrawal.

Epinephrine

Initial hypertensive episode followed by bradycardia may occur.

Ergot derivatives

Peripheral ischemia, manifested by cold extremities and possible gangrene, may occur.

Insulin

Prolonged hypoglycemia with masking of symptoms may occur.

Lidocaine

Lidocaine levels may increase, leading to toxicity.

NSAIDs

Some agents may impair antihypertensive effect.

Prazosin

Orthostatic hypotension may be increased.

Verapamil

Effects of both drugs may be increased.

Laboratory Test Interactions

Serum glucose may decrease; may interfere with glucose or insulin intolerance tests.

Adverse Reactions

Cardiovascular

Bradycardia; hypotension; CHF; cold extremities; heart block; worsening angina; edema.

CNS

Depression; fatigue; lethargy; drowsiness; short-term memory loss; headache; dizziness.

Dermatologic

Alopecia; rash.

EENT

Dry eyes; visual disturbances.

GI

Nausea; vomiting; diarrhea.

Genitourinary

Impotence; urinary retention; difficulty with urination.

Hematologic

Agranulocytosis.

Metabolic

May increase or decrease blood glucose; elevated triglycerides and total cholesterol; decreased HDL cholesterol.

Respiratory

Wheezing; bronchospasm; difficulty breathing.

Miscellaneous

Increased sensitivity to cold.

Precautions

Warnings

Abrupt withdrawal

In patients with angina pectoris or coronary artery disease (CAD), abrupt withdrawal may cause exacerbation of angina, occurrence of MI and ventricular arrhythmias. Monitor patients closely. Because CAD is common and unrecognized, it may be prudent not to discontinue beta-blocker therapy abruptly in patients treated only for hypertension.


Pregnancy

Category C .

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Renal Function

Reduced dosage advised in patients with renal impairment.

Hepatic Function

Reduced dosage advised in patients with hepatic impairment.

Abrupt withdrawal

Beta-blocker withdrawal syndrome (eg, hypertension, tachycardia, anxiety, angina, MI) may occur 1 to 2 wk following sudden discontinuation of systemic beta-blocker therapy. Withdraw treatment gradually over 1 to 2 wk.

Anaphylaxis

Deaths have occurred; aggressive therapy may be required.

CHF

Administer cautiously in CHF patients controlled by digitalis and diuretics. Notify health care provider at first sign or symptom of CHF or unexplained respiratory symptoms in any patient.

Diabetics

May mask signs and symptoms of hypoglycemia (eg, tachycardia, BP changes). May potentiate insulin-induced hypoglycemia.

Nonallergic bronchospasm

Give drug with caution in patients with bronchospastic disease.

Peripheral vascular disease

May precipitate or aggravate symptoms of arterial insufficiency.

Thyrotoxicosis

May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm.

Overdosage

Symptoms

Bradycardia, cardiogenic shock, intraventricular conduction disturbances, hypotension, AV block, depressed consciousness, CHF, asystole, coma.

Patient Information

  • Teach patient how to measure pulse rate before taking medication. Explain that if pulse rate is less than 50 bpm, patient needs to discontinue taking medication immediately and notify health care provider.
  • Ensure that patient has independently demonstrated how to measure pulse rate.
  • Show patient how to monitor blood sugar levels, and explain that signs and symptoms of low blood sugar levels may be masked.
  • Caution patient not to stop taking medication abruptly but to consult health care provider for instructions on safest way to discontinue medication.
  • Instruct patient to report the following symptoms to health care provider: bradycardia, palpitations, dizziness, fatigue, insomnia or sleep disturbances, altered sensorium, GI symptoms, and changes in blood sugar levels.
  • Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
  • Instruct patient not to take OTC medications without consulting health care provider.

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