Nurses Compass
Drug Guide
Nadolol
Classification
Therapeutic: Antianginal, Antihypertensive
Pharmacological: Beta-adrenergic blocker (non-selective)
FDA Approved Indications
- Hypertension
- Angina pectoris
- Migraine prophylaxis
Mechanism of Action
Nadolol is a non-selective beta-adrenergic blocker that inhibits beta-adrenergic receptors in the heart and blood vessels, leading to decreased heart rate, myocardial contractility, and blood pressure, thereby reducing oxygen demand and alleviating angina.
Dosage and Administration
Adult: Initially 40 mg once daily; may increase to 120-160 mg once daily based on response.
Pediatric: Use is not well established; consult specific guidelines.
Geriatric: Start at lower doses due to increased sensitivity; monitor for adverse effects.
Renal Impairment: Adjust dose based on renal function, as nadolol is excreted renally.
Hepatic Impairment: No specific adjustment required, but monitor closely.
Pharmacokinetics
Absorption: Well absorbed orally, with peak plasma levels in 2-4 hours.
Distribution: Widely distributed; crosses the placenta and enters breast milk.
Metabolism: Minimal hepatic metabolism.
Excretion: Primarily unchanged in urine.
Half Life: 12-24 hours
Contraindications
- Sinus bradycardia
- Second- or third-degree AV block
- Cardiogenic shock
- Severe form of peripheral arterial circulatory disturbances
Precautions
- Asthma or other bronchospastic conditions
- Diabetes mellitus (may mask hypoglycemia symptoms)
- Thyrotoxicosis (may mask symptoms)
Adverse Reactions - Common
- Bradycardia (Common)
- Fatigue (Common)
- Dizziness (Common)
- Gastrointestinal disturbances (Common)
Adverse Reactions - Serious
- Severe bradycardia or heart block (Rare)
- Bronchospasm in asthma patients (Rare)
- Hypoglycemia masking in diabetics (Rare)
Drug-Drug Interactions
- Calcium channel blockers (e.g., verapamil, diltiazem) - may increase risk of bradycardia and AV block.
- Other antihypertensives - additive effects.
Drug-Food Interactions
- No significant interactions noted.
Drug-Herb Interactions
- Caution with herbal supplements affecting blood pressure or heart rate.
Nursing Implications
Assessment: Monitor blood pressure, heart rate, and for signs of heart failure.
Diagnoses:
- Risk for decreased cardiac output
- Ineffective tissue perfusion
Implementation: Administer without regard to meals; monitor vitals regularly; caution in starting or stopping therapy to avoid rebound hypertension or angina.
Evaluation: Assess blood pressure and heart rate for therapeutic response and adverse effects.
Patient/Family Teaching
- Instruct patient to take medication exactly as prescribed.
- Advise to rise slowly to prevent orthostatic hypotension.
- Warn about symptoms of bradycardia (e.g., dizziness, weakness).
- Notify provider if experiencing symptoms of asthma or unusual fatigue.
Special Considerations
Black Box Warnings: N/A
Genetic Factors: No specific genetic considerations.
Lab Test Interference: May affect certain lab results, such as blood glucose levels.
Overdose Management
Signs/Symptoms: Severe bradycardia, hypotension, bronchospasm, hypoglycemia.
Treatment: Discontinue medication, provide supportive care (e.g., IV fluids, atropine for bradycardia), and consider dialysis in severe cases.
Storage and Handling
Storage: Store at room temperature, away from moisture and heat.
Stability: Stable for 2-3 years when properly stored.