NADOLOL
Drugs in Pregnancy and Lactation.
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Name: NADOLOL
Class: Sympatholytic (Antihypertensive)
Risk Factor: CM*
Fetal Risk Summary
Nadolol is a nonselective b-adrenergic blocking agent used for hypertension and angina pectoris. The drug is not teratogenic in rats, hamsters, and rabbits, but embryotoxicity and fetotoxicity were observed in the latter species (1,2).
In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 71 newborns had been exposed to nadolol during the 1st trimester (F. Rosa, personal communication, FDA, 1993). One (1.4%) major birth defect was observed (three expected), a cardiovascular defect (one expected).
Only one published case of the use of nadolol in pregnancy has been located (3). A mother with immunoglobulin A nephropathy and hypertension was treated throughout pregnancy with nadolol, 20 mg/day, plus a diuretic (triamterene/hydrochlorothiazide) and thyroid. The infant, delivered by emergency cesarean section at 35 weeks' gestation, was growth retarded and exhibited tachypnea (68 breaths/minute) and mild hypoglycemia (20 mg/dL). Depressed respirations (23 breaths/minute), slowed heart rate (112 beats/minute), and hypothermia (96.5°F) occurred at 4.5 hours of age. The lowered body temperature responded to warming, but the cardiorespiratory depression, with brief episodes of bradycardia, persisted for 72 hours. Nadolol serum concentrations in cord blood and in the infant at 12 and 38 hours after delivery were 43, 145, and 80 ng/mL, respectively. The cause of some or all of the effects observed in this infant may have been b-blockade (3). However, maternal disease could not be excluded as the sole or contributing factor behind the intrauterine growth retardation and hypoglycemia (3). In addition, hydrochlorothiazide may have contributed to the low blood glucose (see Chlorothiazide).
The authors identified several characteristics of nadolol in the adult that could potentially increase its toxicity in the fetus and newborn, including a long serum half-life (17–24 hours), lack of metabolism (excreted unchanged by the kidneys), and low protein binding (30%) (3). Because of these factors, other b-blockers may be safer for use during pregnancy, although persistent b-blockade has also been observed with acebutolol and atenolol. As with other agents in this class, long-term effects of in utero b-blockade have not been studied but warrant evaluation.
Some b-blockers may cause intrauterine growth retardation, such as may have occurred in the case above, and reduced placental weight (e.g., see also Atenolol and Propranolol). Because the number of patients treated in the 1st trimester is much lower than the number exposed later in pregnancy, the greatest weight reductions have been observed when treatment began early in the 2nd trimester. This toxicity has not been consistently demonstrated in other agents within this class, but the relatively few pharmacologic differences among the drugs suggests that the reduction in fetal and placental weights probably occurs with all at some point. The lack of toxicity documentation may reflect the number and type of patients studied, the duration of therapy, or the dosage used, rather then a true difference among b-blockers. Although growth retardation is a serious concern, the benefits of maternal therapy with b-blockers may, in some cases, outweigh the risks to the fetus and must be judged on a case-by-case basis.
[*Risk Factor D if used in 2nd or 3rd trimester.]
Breast Feeding Summary
Nadolol is excreted into breast milk (3,4). A mother taking 20 mg of nadolol/day had a concentration in her milk of 146 ng/mL 38 hours after delivery (3). In 12 lactating women ingesting 80 mg once daily for 5 days, mean steady-state levels of nadolol, approximately 357 ng/mL, were attained at 3 days. This level was approximately 4.6 times higher than simultaneously measured maternal serum levels (4). By calculation, a 5-kg infant would have received 2%–7% of the adult therapeutic dose, but the infants were not allowed to breast-feed (4).
Because experience is lacking, nursing infants of mothers consuming nadolol should be closely observed for symptoms of b-blockade. Long-term effects of exposure to b-blockers from milk have not been studied but warrant evaluation. The American Academy of Pediatrics considers nadolol to be compatible with breast feeding (5).
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References
- Product information. Corgard. Bristol Laboratories, 1993.
- Saegusa T, Suzuki T, Narama I. Reproduction studies of nadolol: a new b-adrenergic blocking agent. Yakuri to Chiryo 1983;11:5119–38. As cited in Shepard TH. Catalog of Teratogenic Agents. 6th ed. Baltimore, MD: Johns Hopkins University Press, 1989:440.
- Fox RE, Marx C, Stark AR. Neonatal effects of maternal nadolol therapy. Am J Obstet Gynecol 1985;152:1045–6.
- Devlin RG, Duchin KL, Fleiss PM. Nadolol in human serum and breast milk. Br J Clin Pharmacol 1981;12:393–6.
- Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.
Q&A about Nadolol
my dr. has prescribed this for me and nowhere can i find that mentioned on the web
The expected results was rapid muscle contraction of upper heart chamber.
People with AF were usually given drugs that can slow down heart rate like Nadolol. (they also given anti coagulant to prevent the risk of CVA or brain stroke).
Nadolol is a B-Blocker type of anti hypertensive drug that makes the heart beat slower and relaxes the blood vessels so that the heart doesnt need to pump too hard no more.
I have been on nadolol for my MVP for several years. I have recently been told that I can stop taking the medicine or cut it in half when I exercise since my blood pressure keeps dropping low. I am in my early 20's and jog over an hour whenever I get a chance. Is this common, to cut the heart medicine in half because blood pressure? Should I have any worries about how my heart is while I'm running--like it going too fast, since the medicine makes it go slower? (I have this worry of something happening if I don't take as much, I guess since I have been on it for so long).
If the drug is continued, is there a chance the adverse effects will dissipate over time?
Side effects include: shortness of breath, lightheadedness, fatigue, weakness...and, have had a darn headache since I started taking them a week ago. Kind of a weirdo contradiction given that I am taking the drug for migraine with aura.
NB: I KNOW this is a question for my neurologist. In Canada, however, one has to wait a while for specialist appointments, so just looking for some affirmation/information in the meantime.
K, Maybe you Are Having Severe Effects From the Medication, Perhaps Most or All Will Disappear With Time, I Suggest, if you Can Handle Them, Stick it Out, Remember, for Migraine this is ~1 Month (Remind you of Antidepressants?), the Payoff Would Be Great.
I don't Know for Sure if there is Any Relation Between Thyroid Function and True Migraine, I Would Have to Look it Up, I was Thinking About Hypotension.
Thanks K, but Allow me to Emphasize, TRUE Migraine.
BTW K, I Think, Someone Having In-Depth Knowledge of their Condition, is Helpful.
K, it has Been my Experience, if Someone Knows their S$$$, they Need Not Fear Knowledge, Perhaps Something Will Be Learned.
K, Many people Get Along Very Well By Window Dressing. And Live In Fear of Discovery.
K, Are you Typically Up So Late At Night?
K, I am Typically Up Late too, Less Interruptions, I Have Seen Simulated Concern Many Times, Maybe it is a Defense Mechanism, or "Blame the person", or Both, In Any Case it Makes the Individual Feel Better, and Do Little or Nothing.
K, Do you Intend to Do a Post-Doc Somewhere, Or Go Into Private Industry?
K, we Are Both In the Eastern Time Zone, I am In Indiana.
Thanks K.
K, I Like Small Towns, Many people Have an Image of Rural Society, Which I don't Share.
K, I am Without Specialization. I Think a GP is the Closest Thing, I had to Drop Out of my Ophthalmology Program.
K, Severe Neurological Problems, Which Kept me From Going On, Maybe, In the End, it Will Be Better.
Thanks K, you Just Never Know, I've Given Many Presentations, Like With Tests, I am Always Nervous, Perhaps the Nadalol Will Be Helpful. About Migraines, I Heard Long Ago, that With Many people, they Become More Frequent (I don't Recall What this is Called, Acceleration?), I'm Fortunate, I Never Got them Often, ~1-2 a Year, None for a Long Time, Which is Interesting. About the Urban/Rural Thing, I Think What Would Be Optimal, Would Be Some Combination of Both, they Both Have Good and Bad Things.
K, Not Everyone Would Turn Down a Script for Ativan.
Cool K, Hope it Works, it did for Me.
I have been taking nadolol for a month now for my blood preassure and just recently I started noticing weird changes in my moods and alot of depression. I had depression before but it was somethin I could control...but this depression I have now is really bad...I dont even know where it came from. I'm just wondering if its a side effect of Nadolol...please help!
(Even if you weren't taking Nadolol, your doctor should know that you're wrestling with depression.)
I truly hope you feel better. Best wishes.
(I didn't know anything about Nadolol's side effects, but this page says that you should tell your doctor if you notice depression --->
http://www.clevelandclinic.org/health/he...
And, it is listed as a drug that causes depression on this site ---> http://www.alternativementalhealth.com/a...
You're very perceptive.
I was just prescribed 20 mg for help with my regular headaches. Just wondering if anyone has experience with this medication. If so, did you experience any side effects?
If you want to know anything specific, please feel free to email me. Being a nurse, I am also familiar with the medication past my own experience with it.
Im 19 and ive been diagnosed with a minor case of IQ syndrome- to make sure i dont have any problems im on 20 MG of Nadolol twice a day- but just like any teen i like to party and get drunk (all of which i was doing b4 this problem arouse) and now im in a situation- i belive i can drink safely with my condition b/c i have done so so many times, but im not sure about the medicine; will it dangeroulsy decrease my heart rhythm, not work at all, or not cause any problems....i understand mixing alcohol with drugs isnt good but can some tell me how bad it actually will be for me? THank you
and please no comments telling me not to drink cause im too young
Web site has other information as well
P.S Are you too young?
I was recently put on 80 mg of Nadolol/daily. I'm 5'4", weigh about 115 lbs. I used to drink (like everyone else) before I was put on this, but I haven't since, and I was wondering if anyone knows how much I can drink? It's kind of annoying sitting around watching all of your friends drink when all you want to do is have a fun time. Thanks :)
Oh, and my sister is on it as well, and she goes out to bars, etc. But she's on 20 mg.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Less common
Breathing difficulty and/or wheezing; cold hands and feet; mental depression; shortness of breath; slow heartbeat (especially less than 50 beats per minute); swelling of ankles, feet, and/or lower legs.
Rare
Back pain or joint pain; chest pain; confusion (especially in elderly patients); dark urine—for acebutolol, bisoprolol, or labetalol; dizziness or lightheadedness when getting up from a lying or sitting position; fever and sore throat; hallucinations (seeing, hearing, or feeling things that are not there); irregular heartbeat; red, scaling, or crusted skin; skin rash; unusual bleeding and bruising; yellow eyes or skin—for acebutolol, bisoprolol, or labetalol.
Signs and symptoms of overdose (in the order in which they may occur)
Slow heartbeat; dizziness (severe) or fainting; fast or irregular heartbeat; difficulty in breathing; bluish-colored fingernails or palms of hands; convulsions (seizures).
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
