Nadolol IV Administration: Critical Warning
Nadolol does not have an FDA-approved intravenous formulation and should NOT be administered intravenously in routine clinical practice. 1
Key Facts About Nadolol Formulations
- Nadolol is only FDA-approved for oral administration 1
- The FDA drug label specifies oral dosing only, with no intravenous formulation approved 1
- Nadolol tablets may be administered without regard to meals 1
Research on Investigational IV Nadolol
While investigational IV nadolol has been studied in research settings, this is not standard practice:
Supraventricular Tachycardia (Research Only)
- In a 1987 research study, IV nadolol was given at sequential doses of 0.01,0.02, and 0.04 mg/kg at 10-minute intervals, with a maximum total dose of 10 mg 2
- This resulted in 79% response rate for controlling ventricular rate in sustained SVT 2
- A pediatric study used similar IV dosing during electrophysiologic studies, with 5 of 7 patients showing excellent response 3
Important Safety Considerations
- Adverse effects in research included asymptomatic hypotension and wheezing 2
- These were investigational protocols, not approved clinical practice 2, 3
Recommended Clinical Approach
For acute rate control or arrhythmia management requiring IV beta-blockade, use FDA-approved IV beta-blockers instead:
Preferred IV Beta-Blockers
- Metoprolol IV: 2.5-5 mg bolus over 2 minutes, up to 3 doses 4
- Esmolol IV: 500 μg/kg bolus over 1 minute, then 50-300 μg/kg/min infusion 4
- Propranolol IV: 1 mg over 1 minute, repeat as needed every 2 minutes up to 3 doses 4
Oral Nadolol Dosing (FDA-Approved)
If nadolol is the desired beta-blocker, use oral administration only 1:
- Hypertension: Initial dose 40 mg once daily, may increase in 40-80 mg increments; usual maintenance 40-80 mg daily (maximum 320 mg/day) 1
- Angina: Initial dose 40 mg once daily, may increase in 40-80 mg increments at 3-7 day intervals; usual maintenance 40-80 mg daily (maximum 240 mg/day) 1
- Supraventricular tachycardia (off-label): 0.5-2.5 mg/kg/day once daily in pediatric patients 3, 5; 40-240 mg daily in adults 4
Critical Contraindications (All Routes)
- Signs of heart failure or low output state 1
- Increased risk for cardiogenic shock 1
- PR interval >0.24 seconds or second/third-degree heart block 1
- Active asthma or reactive airways disease 1
- Bronchospastic diseases 1
Common Pitfall to Avoid
Do not attempt to create an extemporaneous IV preparation from oral nadolol tablets - there is no established safety or efficacy data for this practice, and FDA-approved IV alternatives exist 4.