Formulary
Nadolol: Indications, Dosing, Side Effects and Interactions
Nadolol clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Nadolol: Indications, Dosing, Side Effects and Interactions
Nadolol clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): Initially 80 mg once daily, then increased in steps of up to 80 mg every week if required, doses higher than the maximum are rarely necessary; maximum 240 mg per day.
**Angina**
- **Adult** (By Mouth): Initially 40 mg once daily, then increased if necessary up to 160 mg daily, doses should be increased at weekly intervals, maximum dose rarely is used; maximum 240 mg per day.
**Arrhythmias**
- **Adult** (By Mouth): Initially 40 mg once daily, then increased if necessary up to 160 mg once daily, doses should be increased at weekly intervals; reduced to 40 mg daily if bradycardia occurs.
**Migraine prophylaxis**
- **Adult** (By Mouth): Initially 40 mg once daily, then increased in steps of 40 mg every week, adjusted according to response; maintenance 80-160 mg once daily.
**Thyrotoxicosis (adjunct)**
- **Adult** (By Mouth): 80-160 mg once daily.
Cautions
For all beta-adrenoceptor blockers (systemic) Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: in combination with verapamil or diltiazem (risk of heart block) with bradycardia (heart rate less than 50 beats per minute), or second- or third-degree AV block (contra-indicated; risk of complete heart block, asystole) in diabetes mellitus patients with frequent hypoglycaemic episodes (risk of suppressing hypoglycaemic symptoms) if prescribed a non-selective beta-blocker (including topical beta-blockers) in a history of asthma requiring treatment (contra-indicated in asthma; risk of increased bronchospasm)
Contraindications
For all beta-adrenoceptor blockers (systemic) Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal's angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure Contra-indications, further information Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.
Side effects
For all beta-adrenoceptor blockers (systemic) Common or very common Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; rash (reversible on discontinuation); Raynaud's phenomenon; sleep disorders; syncope; visual impairment; vomiting Uncommon Alopecia; atrioventricular block; bronchospasm Rare or very rare Hallucination; psoriasis exacerbated Side-effects, further information With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. Overdose Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. For details on the management of poisoning, see Beta-blockers, under Emergency treatment of poisoning . Side-effects For nadolol Common or very common Peripheral vascular disease Uncommon Appetite decreased; behaviour abnormal; constipation; cough; dry mouth; dyspepsia; facial swelling; flatulence; hyperhidrosis; nasal congestion; sedation; sexual dysfunction; skin reactions; speech slurred; tinnitus; vision blurred; weight increased Frequency not known Hypoglycaemia
Interactions
**Severe interactions:**
- Lidocaine, IV Significant reduction of lidocaine clearance can occur when a beta-blocker is administered concurrently.
**Other interactions (13):**
- Catecholamine-depleting drugs Additive effects may occur with nadolol; monitor closely for evidence of hypotension and/or excessive bradycardia (e.g.
- Antihypertensives ( e.g.
- Clonidine If Nadolol and clonidine are given concurrently, clonidine should not be discontinued until several days after Nadolol withdrawal.
- Antidiabetic drugs (oral agents and insulin) Hypoglycaemia or hyperglycaemia; adjust dosage of anti-diabetic drug accordingly (see Diabetes and Hypoglycaemia in section 4.4 Special warnings and...
- Monoamine oxidase inhibitors (MAOIs) Isolated cases of bradycardia have occurred during concurrent use of beta-blockers and MAOIs.
- Antimuscarinic agents May counteract the bradycardia caused by beta-blockers.
Pregnancy
For all beta-adrenoceptor blockers (systemic) Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension.
Breast feeding
For all beta-adrenoceptor blockers (systemic) With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants. Breast feeding For nadolol Water soluble beta-blockers such as nadolol are present in breast milk in greater amounts than other beta blockers.
Hepatic impairment
Manufacturer advises caution.
Renal impairment
Dose adjustments Increase dosage interval if eGFR less than 50 mL/minute/1.73 m 2 .
Medicinal forms
Tablet
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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