What is the use of Nadolol (beta blocker)?

From the Guidelines

Nadolol is a non-selective beta-blocker medication primarily used to treat high blood pressure, angina (chest pain), and certain heart rhythm disorders, with a typical starting dose of 40 mg once daily, which can be gradually increased to 80-240 mg daily depending on patient response, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. The medication works by blocking beta-adrenergic receptors in the heart and blood vessels, reducing heart rate and blood pressure by decreasing the force of heart contractions and relaxing blood vessels. Some key points to consider when using nadolol include:

• It is not recommended for patients with reactive airways disease, such as asthma or severe COPD, due to the risk of bronchospasm 1.
• It should be avoided in patients with certain heart blocks or severe heart failure, as it can worsen these conditions 1.
• The medication can cause common side effects such as fatigue, dizziness, cold extremities, and bradycardia (slow heart rate) 1.
• When discontinuing nadolol, it should be tapered gradually over 1-2 weeks rather than stopped abruptly to prevent rebound hypertension or worsening angina 1.
• Patients should take nadolol consistently at the same time each day and monitor their blood pressure and heart rate regularly 1. It's also worth noting that nadolol has a long half-life, allowing for once-daily dosing, which can improve medication adherence 1. Additionally, the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults recommends nadolol as a first-line therapy in the treatment of hypertension when it occurs in patients with stable ischemic heart disease (SIHD) 1. Overall, nadolol is a effective medication for the treatment of high blood pressure, angina, and certain heart rhythm disorders, but it should be used with caution in certain patient populations and under the guidance of a healthcare professional.

From the FDA Drug Label

Nadolol is a nonselective beta-adrenergic receptor blocking agent By blocking catecholamine-induced increases in heart rate, velocity and extent of myocardial contraction, and blood pressure, nadolol generally reduces the oxygen requirements of the heart at any given level of effort, making it useful for many patients in the long-term management of angina pectoris The mechanism of the antihypertensive effects of beta-adrenergic receptor blocking agents has not been established; however, factors that may be involved include ... competitive antagonism of catecholamines at peripheral (non-CNS) adrenergic neuron sites (especially cardiac) leading to decreased cardiac output, ... and suppression of renin secretion by blockade of the beta-adrenergic receptors responsible for renin release from the kidneys.

The use of Nadolol (beta blocker) is for the long-term management of:

• Angina pectoris
• Hypertension 2

From the Research

Uses of Nadolol

• Nadolol is a nonselective beta-adrenoceptor blocking drug used to treat hypertension and angina pectoris 3.
• It is suitable for once daily administration due to its long duration of activity, making it effective in managing both hypertension and angina 3, 4.
• Nadolol has been shown to be safe and effective for long-term treatment of hypertension and angina, with improvements in renal function as measured by serum creatinine levels 4.
• It can be used in combination with other medications, such as hydrochlorothiazide, to control hypertension 5.
• Nadolol has been found to inhibit exercise-induced changes in blood pressure and heart rate, and its antihypertensive effect is proportional to its minimum steady-state serum concentration 6.
• It is effective and well-tolerated as once-daily monotherapy for mild to moderate essential hypertension in both young and elderly adults 7.

Therapeutic Efficacy

• Nadolol has been shown to be as effective as propranolol in treating hypertension and angina, with the advantage of once daily administration 3.
• It has been found to reduce supine diastolic blood pressure and heart rate in patients with essential hypertension 6.
• Nadolol has been used to control hypertension in combination with hydrochlorothiazide, with a high response rate and minimal side effects 5.

Pharmacokinetics and Pharmacodynamics

• Nadolol is excreted entirely in unmetabolized form, which may offer advantages over other beta-blocking drugs in specific patients 3.
• Its pharmacodynamic and pharmacokinetic properties make it suitable for once daily administration, with a long duration of activity 3, 4.
• Nadolol's antihypertensive effect is related to its minimum steady-state serum concentration, and it has been found to increase plasma norepinephrine concentration and decrease isoproterenol sensitivity 6, 7.