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nadolol (Rx)Brand and Other Names:Corgard

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 20mg
  • 40mg
  • 80mg
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Hypertension

40-320 mg PO qDay

Angina Pectoris

Initial 40 mg/day PO, increase gradually q 3-7Days

Doses up to 160-240mg qDay may be needed

SVT, Maintenance (Off-label)

60-160 mg/day PO

Aggressive Behavior; Upper GI Rebleed (Off-label)

40-160 mg/day PO

Migraine, Prophylaxis (Off-label)

40-80 mg PO qDay (up to 240 mg/day)

Renal Impairment

CrCl >50 mL/min: Give qDay

CrCl 31-50 mL/min: Give q24-36hr

CrCl 10-30 mL/min: Give q24-48hr

CrCl <10 mL/min: Give q40-60hr

Hepatic Impairment

Dose adjustments not necessary

Additional Information

Less effective than thiazide diuretics in black and geriatric patients

Shown to decrease mortality in hypertension and post-myocardial infarction

Other Indications & Uses

Off-label: Arrhythmias, GI bleed, hyperthyroidism, reduce IOP, SVT

Not approved

Hypertension

20-320 mg PO qDay

Angina Pectoris

Initial 20 mg/day PO, increase gradually q 3-7Days

Doses up to 160-240mg qDay may be needed

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Interactions

Interaction Checker

nadolol and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Drowsiness

            Insomnia

            Decreased sexual ability

            1-10%

            Bradycardia (2%)

            Dizziness (2%)

            Fatigue (2%)

            Hypotension (1%)

            <1%

            Abdominal discomfort

            Constipation

            Diarrhea

            Nausea

            Cough

            Nasal congestion

            Frequency Not Defined

            Bronchospasm, depression, decreased exercise tolerance, Raynaud's phenomenon

            May increase triglyceride levels and insulin resistance, and decrease HDL levels

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            Warnings

            Black Box Warnings

            May exacerbate ischemic heart disease following abrupt withdrawal

            Hypersensitivity to catecholamines has been observed during withdrawal

            Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuation

            When discontinuing chronically administered beta-blockers (particularly with ischemic heart disease) gradually reduce dose over 1-2 wk and carefully monitor

            If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina)

            Warn patients against interruption or discontinuation of beta-blocker without physician advice

            Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension

            Contraindications

            Hypersensitivity

            Overt cardiac failure, 2°/3° heart block, cardiogenic shock

            Asthma/COPD

            Avoid during breastfeeding

            Sinus bradycardia

            Sick sinus syndrome without permanent pacemaker

            Cautions

            Anesthesia/surgery (myocardial depression); chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

            Nonallergenic bronchospasm, cerebrovascular insufficiency, well-compensated CHF, DM, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease

            Sudden discontinuation can exacerbate angina and lead to myocardial infarction

            Increased risk of stroke after surgery

            Use in pheochromocytoma

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: concentrated in breast milk, use caution (AAP Committee states compatible w/ nursing)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Blocks response to beta-adrenergic stimulation to beta1 and beta2 receptors; may reduce portal pressure through beta2 receptor, which reduces portal blood flow

            Pharmacokinetics

            Half-Life: 10-24 hr

            Onset: 3-4 hr

            Duration: 17-24 hr

            Vd: 1.9 L/kg (1.88-2.02 L/kg)

            Peak Plasma Time: 2-4 hr

            Bioavailability: 20-40%

            Protein Bound: 28-30%

            Metabolism: None

            Excretion: Urine

            Dialyzable: Yes (HD)

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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