Nadolol (Oral)

Overview

Nadolol is a beta blocker used to treat hypertension, high blood pressure, and angina (chest pain due to an inadequate blood supply to the heart). High blood pressure makes the heart and arteries worker harder which causes damage if left untreated. This damage includes the blood vessels in the brain which can lead to a stroke, and in the heart or kidneys which cause organ failure and increased risk of heart attack. Angina is caused by the blood supply to the heart decreasing resulting in a lack of oxygen which increases the chances of heart attack, cardiac arrest, and irregular heart rhythm. To decrease the blood pressure and increase the amount of oxygen and blood to the heart, medication that slows the heart rate helps the heart work properly and damage to tissue is avoided with treatment.

Nadolol is a beta blocker which blocks beta receptors in the heart and blood vessels after stress hormones such as adrenaline bind to the beta receptors and cause reactions in the body. Basically, it works by relaxing blood vessels which slows the heart rate to improve blood flow and decrease blood pressure. These reactions can be in the form of increased heart rate or the force of blood pumped through the heart. It can result in higher blood pressure and constricted blood vessels. Nadolol is sometimes used to treat migraines, irregular heartbeat, and tumors caused by Parkinson's disease.

Conditions Treated

  • Hypertension
  • Angina

Type Of Medicine

  • Beta blocker

Side Effects

It is very important for the doctor to monitor patients regularly to ensure medication is working properly and to check for any side effects. While Nadolol is usually well tolerated, it can have dangerous side effects in patients with some pre-existing medical conditions. Some side effects are not reported and it is important to tell the doctor about unusual symptoms or problems that arise after starting medication. It may cause heart failure in some patients and it is important to contact the doctor immediately if any of the following occur.

  • Chest pain or discomfort
  • Dilated veins in the neck
  • Extreme fatigue
  • Breathing problems
  • Swelling or weight gain

The most common side effects reported affect the cardiovascular and nervous systems.

Common side effects

  • Bradycardia
  • Cardiac failure
  • Rhythm or conduction disturbance
  • Peripheral vascular insufficiently
  • Hypotension
  • Dizziness
  • Fatigue

Following are some less common side effects that may require medical treatment.

Less common side effects

  • Confusion or changes in behavior
  • Problems with speech or vision
  • Irregular or slow heart beat

Nadolol can cause changes in blood sugar levels and cover up some signs of low blood sugar. It is important to consult the doctor about any change in blood or urine sugar tests. It is also important to tell other doctors and dentists about Nadolol prescription especially if surgery is required because this medication cannot be taken for a week or so before surgery. Nadolol can cause a dangerously slow heart rate and even shock in patients with existing bradycardias and heart blocks. Patients who have asthma, chronic bronchitis, or emphysema may experience worsening of their breathing difficulties.

Dosage

This medication is not a cure for high blood pressure and may need to be taken for life. It is important to follow the doctor's directions on medication, exercise, and diet to reduce sodium and control weight. Nadolol must be taken as directed to lower blood pressure and should be taken even when patients feel healthy to keep blood pressure down. Keep all appointments so the doctor can carefully monitor progress. Never suddenly stop taking the medicine because it can cause problems to worsen. The doctor must gradually reduce dosage over the course of a few weeks to prevent complications.

The dosage the doctor prescribes is based on a number of factors and is different for each patient.

  • Condition treated
  • Severity of condition
  • Response to medication
  • Other medications taken
  • Other medical conditions

Because dosage may be different, it is important to follow the doctor's directions on the label. The medical condition being treated will determine the number of doses and amount of time in between doses each day. It also determines how long the prescription will need to be taken for. The initial dose may be increased gradually until the desired effects are achieved to maintain blood pressure and heart rate. Once pronounced heart rate or blood pressure reduction is achieved, the doctor then prescribes a maintenance dosage to keep rates at the desired level. The following are only average doses for adults and the doctor may adjust as needed, consult a doctor for children's dosage.

Dosage for angina once daily

  • Initial dose 40mg
  • Maintenance dose 40 to 80mg
  • Maximum dose 240mg

Dosage for high blood pressure once daily

  • Initial dose 40mg
  • Maintenance dose 40 to 80mg
  • Maximum dose 320mg

If a dose is missed, take it immediately. If the next dose is 8 hours or less away then wait and resume your normal dosing schedule. Never take a double dose of Nadolol because if too much is taken it can lead to an overdose and specific symptoms depend on the individual, how much was taken, and any other substances mixed with it. Treatment for an overdose can include pumping the stomach, dialysis, or other supportive care. Often medication is given to counteract the effects of an overdose such as raising blood pressure and blood sugar, or to open the airway. Seek emergency treatment if there are signs of an overdose.

Signs of an overdose

  • Slow heart rate
  • Low blood pressure
  • Extreme dizziness or fainting
  • Constriction of airway
  • Low blood sugar
  • Congestive heart failure

Interactions

While it is not recommended to use Nadolol with these medications, it is sometimes required. The doctor may prescribe them together, but do not take them unless they have prescribed it and tell any other doctors about taking this or other beta blockers. Some medications increase the chance of side effects and the doctor should be consulted about previous medicine or new medicine including over-the-counter drugs, vitamins, and herbal supplements.

  • Clonidine
  • Crizotinib
  • Diltiazem
  • Dronedarone
  • Epinephrine
  • Fenoldopam
  • Fingolimod
  • Lacosamide
  • Lidocaine
  • Oxymetazoline
  • Rivastigmine
  • Verapamil

When Nadolol is used in combination with the following medications, it can cause serious or life threatening problems. It can result in a complete block in the heart's electrical system and it is important to discuss these medication interaction risks with the doctor. Some may need to be used in combination; however, the doctor may lower the dose or strength to avoid dangerous interactions.

  • Diltiazem
  • Verapamil
  • Amiodarone
  • Digoxin

Do not take any of the following with Nadolol because of the dangerous interactions which can occur. These interactions can cause dangerously low heart rate, heart failure, high blood pressure, stroke, and other problems. For example, anti-inflammatory NSAIDs can affect the medicine's effectiveness at lowering blood pressure. Using other beta blockers or reserpine with Nadolol increases the chances of dangerous side effects. This is not a complete list; always consult the doctor about other medications.

  • Alcohol
  • Multivitamins with minerals
  • Alpha or beta blockers
  • Insulin
  • Calcium channel blockers
  • Arrhythmia medications
  • Clonidine
  • Digoxin
  • NSAIDs
  • Reserpine
  • Green tea

Taking Nadolol with certain diseases and medical conditions can result in dangerous interactions. Nadolol can even cover up symptoms of certain diseases or disorders. It is important to talk to the doctor about any existing medical conditions in order to avoid dangerous reactions or symptoms being covered up by medication. Medication taken to control some medical conditions may interact with Nadolol as well.

Dangerous disease interactions

  • Asthma/Copd
  • Bradyarrhythmia/Av Block
  • Cardiogenic Shock/Hypotension
  • Diabetes
  • Hemodialysis
  • Hypersensitivity
  • Pvd
  • Renal Dysfunction
  • Cerebrovascular Insufficiency
  • Chf
  • Glaucoma
  • Hyperlipidemia
  • Hyperthyroidism
  • Ischemic Heart Disease
  • Myasthenia Gravis
  • Pheochromocytoma
  • Psoriasis
  • Tachycardia
  • Prinzmetal's Variant Angina

Warnings

Both angina and high blood pressure can worsen over time if left untreated. Angina can cause damage to the heart tissue within 30 minutes of not receiving proper oxygen. The blood flow being blocked increases the risk of a heart attack. Besides disabling pain, the heart is affected either by a blockage or irregular heartbeat and can even cause heart attacks, heart failure, or death if left untreated. High blood pressure slowly does damage to the body over a few years if left untreated. Half of the people with untreated high blood pressure die of heart disease related to poor blood flow and a third of the rest die of a stroke. Not only are the heart and arteries damaged, but untreated high blood pressure causes damage to the brain, kidneys, and eyes. Damage can lead to heart failure, aneurysms, stroke, and kidney failure when high blood pressure is left untreated. These are serious and life threatening situations and once the damage is done it cannot be reversed. It is important to continue treatment to avoid a deadly situation or organ failure.

Be sure to tell the doctor about any allegories to medication, food, dyes, or animals along with any medication currently being taken including over-the-counter drugs, vitamins, and herbal supplements. Tell the doctor about any medical conditions because some conditions or medication for the condition can cause a dangerous reaction.

Nadolol can affect blood sugar, worsen blood vessel diseases, and cause difficulty breathing when lung diseases such as bronchitis and emphysema are present. Kidney disease can worsen because of the slow removal of medicine from the body. This medication can also worsen or cover up symptoms of some medical conditions and must be used with caution. Tell the doctor about any of these medical conditions to avoid a dangerous interaction.

Do not use with these medical conditions

  • Asthma or COPD
  • Heart conditions or failure
  • Heart not pumping properly
  • Kidney disease or failure
  • Pregnancy or breastfeeding

Medicine can cover up signs of these conditions

  • Diabetes
  • Hypertension
  • Hypoglycemic

Use with caution with these conditions

  • Blood vessel disease
  • Kidney disease
  • Lung disease

Do not take Nadolol when pregnant or breastfeeding because of the risk to the baby. While no human studies have been done, one reported case of a pregnant mother taking Nadolol resulted in dangerous effects for the newborn including heart and lung problems. Also, it does pass in breast milk and can endanger nursing babies by accumulating the drug in their bodies because their kidneys do not remove the medication the same as adults. The only reported case of effects on a newborn showed the baby was born with the following problems.

  • Growth restriction
  • Slow heart rate
  • Breathing difficulties
  • Low heart rate
  • Low temperature

Storage

Store Nadolol in the tightly closed container it came in at room temperature and keep it away from moisture, direct light, and heat. Do not let medication freeze and do not store it in the bathroom. Keep out of reach of children, pets, and other people. Ask a health care professional how to dispose of unused medicine, and never keep unused or outdated medication. This medication must be properly disposed of and the best way is through a medicine take back program. Talk with a pharmacist or contact your local recycling department to get more information about medicine take back programs.

If there is no access to any take back programs, the FDA suggests mixing the whole tablets with dirt, kitty litter, or used coffee grounds in a zip lock bag before throwing it away. Mixing it with an undesirable substance will reduce the chances of animals, children, and other people from consuming the medication. Remember to scratch out all information on the label before throwing the bottle away. Do not flush any unused medicine down the toilet because Nadolol is a dangerous medication to consume when not being used for treatment of high blood pressure or pain from improper blood flow.

Summary

Clinical studies show Nadolol reduces heart rate and blood pressure as well as reducing tachycardia (heart rate that is faster than normal even at rest), caused by isoproterenol or when standing up. This medication should not be taken if patients have asthma or serious heart conditions including heart failure and problems with the heart pumping blood properly. Tell the doctor about any allergies, medication, diseases and disorders, or if you're pregnant or breastfeeding. Medicines include over-the-counter, vitamins, and herbal supplements and allergies include medicine, food, and preservatives. Since Nadolol affects blood sugar levels, let the doctor know about any blood sugar issues including diabetes and hypoglycemia.

Do not suddenly stop taking this medication because it can have adverse effects if the dosage is not gradually reduced over a few weeks. Just as the doctor may gradually increase the dose to achieve the desired affects, they need to gradually reduce the dose before medicine can be stopped. This is a medicine which may need to be taken for life to control high blood pressure, and should still be taken even if the patient feels well. High blood pressure is treated with more than medicine, and it is important to follow the doctor's directions about diet and exercise to maintain a healthy blood pressure. This medication is only one part of the complete treatment for high blood pressure, and it is important to combine it with a healthy diet and exercise.

Always tell the doctor about any pre-existing medical conditions as well as medicine taken for those conditions. Nadolol has dangerous interactions with some medical problems as well certain types of medication. To avoid increased chance of side effects or heart failure, it is important for the doctor to know if any medical condition or medication exists which can interact with Nadolol. This medication may also worsen or cover up symptoms of some diseases. This includes female patients who are pregnant or nursing. Nadolol can cause problems with the baby's heart or lungs as demonstrated by the only reported case of a pregnant mother taking Nadolol and the baby had multiple medical issues at birth.