Nadolol
| (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/DosageHypertension
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.
InteractionsClonidine: 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 ReactionsCV: 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.
PrecautionsPregnancy: 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 |
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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.
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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.
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