Nadolol

A to Z Drug Facts

Nadolol

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(nay-DOE-lahl)

Corgard, Alti-Nadolol, Apo-Nadol, Novo-Nadolol

Class: Beta-adrenergic blocker

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

Indications 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.

Route/Dosage

Hypertension

ADULTS: PO Initiate with 40 mg/day; titrate in 40 to 80 mg increments to desired response. Maintenance: 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: 40 to 240 mg/day. Dosage intervals may need to be altered in patients with decreased renal function.

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 alkaloids: 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.

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

Adverse Reactions

CV: Bradycardia; hypotension; CHF; cold extremities; heart block; worsening angina; edema. CNS: Depression; fatigue; lethargy; drowsiness; short-term memory loss; headache; dizziness. DERM: Alopecia; rash. EENT: Dry eyes; visual disturbances. GI: Nausea; vomiting; diarrhea. GU: Impotence; urinary retention; difficulty with urination. HEMA: Agranulocytosis. META: May increase or decrease blood glucose; elevated triglycerides and total cholesterol; decreased HDL cholesterol. RESP: Wheezing; bronchospasm; difficulty breathing. OTHER: Increased sensitivity to cold.

Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy not established. 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 physician 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. Renal/Hepatic impairment: Reduced dosage advised. Thyrotoxicosis: May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Assess heart rate and BP before administering medication.
Administer on regular schedule.
Give medication with full glass water, either with or without food.
Discontinue drug gradually over 1 to 2 wk.
Store in tightly-closed, light-resistant container at room temperature.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies. Note CHF, asthma, diabetes mellitus, or hyperthyroidism.
Obtain baseline cardiac assessment including heart rate, BP, capillary refill, pulse rhythm, presence of angina. Monitor BP and pulse frequently during initial phase of therapy and when changing dosage.
If patient is scheduled for surgery, confer with physician regarding use of medication prior to surgery.
For postoperative patients, monitor for trends in heart rate and blood pressure.
Monitor I&O and weigh patient daily.
Withhold medication and notify physician if heart rate is < 60 bpm or systolic BP < 90 mm Hg. Atropine may be needed for treatment of persistent bradycardia.
For diabetic patients receiving hypoglycemic agents, monitor blood glucose test results. Signs and symptoms of hypoglycemia may be masked with nadolol.
For patients discontinuing medication, monitor for signs or symptoms of thyroid storm. Abrupt withdrawal may precipitate thyrotoxicosis.
Observe for signs of beta-blocker withdrawal syndrome (eg, hypotension, tachycardia, anxiety, angina, MI) if medication is discontinued suddenly.
Use caution in patients with CHF, COPD or asthma. Monitor cardiovascular and respiratory status carefully and frequently.

OVERDOSAGE: SIGNS & SYMPTOMS
	Bradycardia, cardiogenic shock, intraventricular conduction disturbances, hypotension, AV block, depressed consciousness, CHF, asystole, coma

Patient/Family Education

Teach patient how to measure pulse rate before taking medication. Explain that if pulse rate is < 50 bpm, patient needs to discontinue taking medication immediately and notify physician.
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 physician for instructions on safest way to discontinue medication.
Instruct patient to report the following symptoms to physician: Bradycardia, palpitations, dizziness, fatigue, insomnia or sleep disturbances, altered sensorium, GI symptoms, 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 physician.