Nadolol
Risk Factor: CM*
Class: CARDIOVASCULAR DRUGS
/ Antihypertensives
/ Other Antihypertensives
Contents of this page:
Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers
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 (96.5F) 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 (1724 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).
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;11:511938. 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;152:10456.
- Devlin RG, Duchin KL, Fleiss PM. Nadolol in human serum and breast milk. Br J Clin Pharmacol 1981;12:3936.
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Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:13750.
Questions and Answers
How long does it take Treximet and Nadolol together to alleviate a migraine?, My doctor gave me Treximet and Nadolol (a beta-blocker) to help alleviate my migraine attacks (usually triggered by physical exertion). It's been two days and I'm seeing a lesser frequency of migraine attacks but I'm still disabled from my life activities, how long will it take to eliminate them altogether?
The Nadolol should work within two weeks if it is going to. The Treximet is just taken as needed when you get a migraine.
You might ask your physician about Topamax. It is FDA approved for migraine prevention and is the best medicine for migraines I've ever seen.
Best Wellness Wishes!
is it ok to take Nadolol and Topamax in the same day?, I have a migraine out the ***!!! I need something to take it away I take Nadolol for them but its not working I do have some topamax is is ok to take them both in the same day?
your doctor prescribed a beta blocker for migraines? I would not mix the two; go to your doctor and check with him. It is better to check with your doctor before mixing any medication, prescribed or not. Drug interactions can be deadly.
has anyone ever heard of nadolol for treatment of atrial fibrillation?, my dr. has prescribed this for me and nowhere can i find that mentioned on the web
Atrial fibrillation is a condition where the electrical impulse of the two upper chamber or atrium of the heart receives disorganize and rapid impulse coming from SA node.
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.
If experiencing adverse effects from taking Nadolol, and the drug is stopped, how long until one feels better?, 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, I Think you Will Experience Rebound Effects, you May Need to Taper Off, I Think your Body Will Compensate for Many Effects of the Drug, Note, Most of the Above Are Effects of Hypotension. BTW, has your Thyroid Function Ever Been Tested?
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.
Nadolol and exercise?, 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).
This doesn't make sense. Exercise will increase your blood pressure, not decrease it. One of the side effects of Nadolol is decreased blood pressure, but that would be more of a problem when you are resting than after exercise. I would go back to the doctor and ask for more information.
Birth Control with Nadolol?, I take 80 mg of Nadolol everyday because of a heart condition i have. Long QT Interval is what it's called; the nadolol is to slow down my heart rate so my heart can take its time and recover between each beat. Can i be prescribed The Pill while on this medication? I dont know if birth control and the beta-blocker will get in each others' way.
It is probably ok to be on the pill at the same time as taking the Nadolol but I would recommend checking with your pharmacist as well to see what they say.
What is Nadolol? Can it mess you up?, I found a bottle with the label ripped off, with small yellow pills inside. The pills say "M" with a line underneath, then "171". I think these pills belong to my brother. Is he using them to get messed up? Why was only the name ripped off? Can you get messed up on Nadodol?
Nadolol is a beta blocker. used for heart conditions.
Is anyone taking Nadolol?, 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!
Please ask your doc about it.
(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.
Has anyone taken Nadolol?, 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?
I currently take Nadolol 40 mg daily and have taken it for years. I take it for high blood pressure. I have experienced no side effects from it at all.
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.
