Nadolol (tablet)

Nadolol
CORGARD® FDA Package Insert
Indications and Usage
Dosage and Administration
Contraindications
Warnings and Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Overdosage
Description
Clinical Pharmacology
Nonclinical Toxicology
How Supplied/Storage and Handling
Patient Counseling Information
Labels and Packages
Clinical Trials on Nadolol
ClinicalTrials.gov

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]

For patient information about Nadolol, click here.

Synonyms / Brand Names: CORGARD^®

Overview

Nadolol (Corgard, Anabet, Solgol, Corzide, Alti-Nadolol, Apo-Nadol, Novo-Nadolol) is a non-selective beta blocker used in the treatment of high blood pressure and chest pain (its only FDA approved uses). Additionally, it is often prescribed in the treatment of migraine headaches, adult attention deficit hyperactivity disorder, essential tremor, and Parkinson's disease.

Category

Beta blockers

FDA Package Insert

CORGARD (nadolol) tablet

Indications and Usage | Dosage and Administration | Dosage Forms and Strengths | Contraindications | Warnings and Precautions | Adverse Reactions | Drug Interactions | Use in Specific Populations | Overdosage | Description | Clinical Pharmacology | Nonclinical Toxicology | Clinical Studies | How Supplied/Storage and Handling | Patient Counseling Information | Labels and Packages

Mechanism of Action

Nadolol is a non-selective beta blocker; that is, it non-selectively blocks both beta-1 and beta-2 receptors. It has a preference for beta-1 receptors, which are predominantly located in the heart, thereby inhibiting the effects of catecholamines and causing a decrease in heart rate and blood pressure. Its inhibition of beta-2 receptors, which are mainly located in the bronchial smooth muscle of the airways, leads to airway constriction similar to that seen in asthma. Inhibition of beta-1 receptors in the juxtaglomerular apparatus of the kidney inhibits the renin-angiotensin system, causing a decrease in vasoconstriction and a decrease in water retention. Nadolol's inhibition of beta-1 receptors in the heart and kidney leads to its effects on lowering blood pressure.

The drug impairs AV node conduction and decreases sinus rate.

Nadolol may also increase plasma triglycerides and decrease HDL-cholesterol levels.

Indications

Nadolol has U.S. Food and Drug Administration approved indications for:

• treatment of hypertension
• long-term treatment of angina pectoris.

Off-label uses

• Neurological disorders

Nadolol is used in the treatment of a number of neurological disorders such as migraine, adult ADHD, essential tremor, Parkinson's disease. Prevention of migraine headaches with nadolol is well documented.

A case report study from Harvard Medical School, published in 1991, described three adult patients with ADHD for whom traditional psychostimulant therapy (with methylphenidate) was either ineffective or wasn't well tolerated. Adding nadolol to the psychostimulant monotherapy resulted in improved attention and focus with decreased side effects. This suggested that combination therapy with nadolol and a psychostimulant (such as methylphenidate or dexamphetamine) might be effective for treatment-resistant ADHD in adults.

Nadolol is also used to control tremors in degenerative diseases of the central nervous system (such as essential tremor) or as an anti-tremor agent in the treatment of Parkinson's disease.

• Long QT syndrome (LQTS)

Nadolol is one of the preferred beta-blockers in the management of patients with LQTS for shortening of the QT interval and prevention of ventricular arrhythmia. It is more efficacious than metoprolol in the prevention of breakthrough cardiac events while on therapy and is equivalent to propranolol. Nadolol has the advantage of once daily dosing and thus improved patient compliance.

Contraindications

Patients whose heart rate is largely mediated by the sympathetic nervous system (e.g. patients with congestive heart failure or myocardial infarct) should avoid nadolol as it inhibits sympathetic function. Nadolol is also contraindicated in patients with bradycardia (slow heart rate) because of its vasodilatory effects and tendency to cause bradycardia.

Because of its beta-2 activity, nadolol causes pulmonary bronchoconstriction and should be avoided in asthma patients in preference of a beta-1 blocker. However, evidence from a 2008 study suggests that long-term non-selective beta-blocker use may actually prove to be beneficial in mild asthma.

Because nadolol, like other beta-2 blockers, inhibits the synthesis and release of glucose in response to hypoglycemia, it slows patients' recovery from acute hypoglycemic episodes and should be avoided in patients getting treatment for diabetes mellitus. In patients with insulin-dependent diabetes, a selective beta-1 blocker is preferred over non-selective blockers.

Side effects

• Bradycardia
• Fatigue
• Bronchospasms

Chemistry

Nadolol is a mixture of stereoisomers. It is polar and hydrophilic, with low lipid solubility.