Nadolol

About Nadolol

Nadolol is a nonselective beta blocker: it blocks beta receptors in the heart and elsewhere in the body, including the airways, which slows the heart rate and lowers blood pressure. The label covers the long-term management of angina pectoris and the treatment of high blood pressure, alone or with other medicines, especially thiazide-type diuretics; safety and effectiveness in children have not been established. Its half-life of about 20 to 24 hours allows one dose a day, with or without food. For both uses the usual start is 40 mg once daily, raised in 40 to 80 mg steps: for angina every three to seven days, usually to 40 or 80 mg a day and sometimes to 160 or 240 mg; for blood pressure usually to 40 or 80 mg and sometimes to 240 or 320 mg.

The label warns about stopping: after beta blockers were stopped abruptly, angina has worsened and in some cases heart attacks have occurred, so when long-term nadolol is stopped the dose is reduced gradually over one to two weeks with careful monitoring, and the label says it may be prudent not to stop it abruptly even when it is taken only for blood pressure. It must not be taken by people with bronchial asthma, sinus bradycardia or heart block beyond first degree, cardiogenic shock or overt heart failure, and people with chronic bronchitis, emphysema or other bronchospastic disease should in general not take beta blockers. It can bring on heart failure, hide the fast heartbeat of low blood sugar or an overactive thyroid, and make low blood sugar more severe or prolonged, and it is not routinely stopped before major surgery. A slow pulse is common; dizziness, tiredness and Raynaud-type circulation symptoms are among the other side effects.

The liver does not break nadolol down; the kidneys clear it unchanged, so with reduced kidney function the doses are spaced out: every 24 to 36 hours at a creatinine clearance of 31 to 50 mL/min, every 24 to 48 hours at 10 to 30, and every 40 to 60 hours below 10. People with a history of severe allergic reactions may react more strongly while taking it and may not respond to the usual doses of epinephrine. It passes into breast milk, and newborns whose mothers took it at delivery have had a slow heart rate and low blood sugar. The Orange Book lists every Corgard strength, including the 120 and 160 mg tablets, and Corzide, its combination with bendroflumethiazide, as discontinued.

Taking Nadolol

How to take it

Once a day, or at the longer interval set for your kidney function, with or without food, at about the same time each day. Keep taking it even if you feel well; only the prescriber stops it, gradually over one to two weeks.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue your regular schedule. Do not take a double dose.

Storage

At room temperature in a tightly closed container, protected from light, heat and moisture, out of reach of children. Use a take-back program for tablets you no longer need rather than flushing them.

Interactions to know about

Digoxin adds to its slowing of the heart, and reserpine and similar drugs can cause low blood pressure or a very slow pulse. Diabetes medicines may need adjusting, general anesthesia can lower blood pressure further, and in people with a history of severe allergic reactions the usual doses of epinephrine may not work. Tell the prescriber about asthma, COPD, diabetes, thyroid disease or kidney disease.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Nadolol differs from pharmacy to pharmacy

Nadolol is an old generic made by several companies, and with Corgard gone every quote is for a generic tablet, so quotes differ with each pharmacy’s own cost, markup and dispensing fee rather than with the brand. A dose above 80 mg takes more than one tablet now that the 120 and 160 mg tablets are gone. With severe kidney impairment doses may be spaced as far apart as every 40 to 60 hours, so a month can mean few tablets, and the dispensing fee can then be much of the quote.

Ways to pay less for Nadolol without insurance

• Ask whether nadolol is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Ask for a ninety-day supply once your dose is settled, so you are less likely to run out of a medicine that should not be stopped suddenly.
• If your dose is above 80 mg, ask the pharmacy to quote the exact tablets that make it up, and ask the prescriber to write it in the fewest tablets the strengths allow.
• If it is hard to find or quoted high, ask the prescriber whether another generic beta blocker would suit you; never stop nadolol on your own while you wait.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Nadolol

1. 1.How would my dose be tapered if it is stopped, and what should I do if I run out?
2. 2.Is my dosing interval adjusted for my kidney function?
3. 3.Is it safe with my asthma, COPD or diabetes medicines?
4. 4.What pulse rate or symptoms mean I should call?

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