Nadolol Recall

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Questions & Answers

Side Effects & Adverse Reactions

Cardiac Failure

Sympathetic stimulation may be a vital component supporting circulatory function in patients with congestive heart failure, and its inhibition by beta-blockade may precipitate more severe failure. Although beta-blockers should be avoided in overt congestive heart failure, if necessary, they can be used with caution in patients with a history of failure who are well-compensated, usually with digitalis and diuretics. Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart muscle.

IN PATIENTS WITHOUT A HISTORY OF HEART FAILURE, continued use of beta-blockers can, in some cases, lead to cardiac failure. Therefore, at the first sign or symptom of heart failure, the patient should be digitalized and/or treated with diuretics, and the response observed closely, or nadolol should be discontinued (gradually, if possible).

Exacerbation of Ischemia Heart Disease Following Abrupt Withdrawal

Hypersensitivity to catecholamines has been observed in patients withdrawn from beta-blocker therapy; exacerbation of angina and, in some cases, myocardial infarction have occurred after abrupt discontinuation of such therapy. When discontinuing chronically administered nadolol, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of one to two weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, nadolol administration should be reinstituted promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician’s advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue nadolol therapy abruptly even in patients treated only for hypertension.

Nonallergic Bronchospasm (e.g., chronic bronchitis, emphysema)

PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD IN GENERAL NOT RECEIVE BETA-BLOCKERS. Nadolol should be administered with caution since it may block bronchodilation produced by endogenous or exogenous catecholamine stimulation of beta2 receptors.

Major Surgery

Because beta-blockade impairs the ability of the heart to respond to reflex stimuli and may increase the risks of general anesthesia and surgical procedures, resulting in protracted hypotension or low cardiac output, it has generally been suggested that such therapy should be withdrawn several days prior to surgery. Recognition of the increased sensitivity to catecholamines of patients recently withdrawn from beta-blocker therapy, however, has made this recommendation controversial. If possible, beta-blockers should be withdrawn well before surgery takes place. In the event of emergency surgery, the anesthesiologist should be informed that the patient is on beta-blocker therapy. The effects of nadolol can be reversed by administration of beta-receptor agonists such as isoproterenol, dopamine, dobutamine, or levarterenol. Difficulty in restarting and maintaining the heart beat has also been reported with beta-adrenergic receptor blocking agents.

Diabetes and Hypoglycemia

Beta-adrenergic blockade may prevent the appearance of premonitory signs and symptoms (e.g., tachycardia and blood pressure changes) of acute hypoglycemia. This is especially important with labile diabetics. Beta-blockade also reduces the release of insulin in response to hyperglycemia; therefore, it may be necessary to adjust the dose of antidiabetic drugs.


Beta-adrenergic blockade may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta-adrenergic blockade which might precipitate a thyroid storm.

Legal Issues

There is currently no legal information available for this drug.

FDA Safety Alerts

There are currently no FDA safety alerts available for this drug.

Manufacturer Warnings

There is currently no manufacturer warning information available for this drug.

FDA Labeling Changes

There are currently no FDA labeling changes available for this drug.


Angina Pectoris

Nadolol tablets are indicated for the long-term management of patients with angina pectoris.


Nadolol tablets are indicated in the management of hypertension; they may be used alone or in combination with other antihypertensive agents, especially thiazide-type diuretics,


There is currently no drug history available for this drug.

Other Information

Nadolol tablets are synthetic nonselective beta-adrenergic receptor blocking agents designated chemically as 1-(tert-butylamino)-3-[(5, 6, 7, 8-tetrahydro-cis-6, 7-dihydroxy-1-naphthyl)oxy]-2-propanol. Structural formula:

Nadolol Chemical Structure

C17H27NO4 M.W. 309.40

Nadolol is a white crystalline powder. It is freely soluble in ethanol, soluble in hydrochloric acid, slightly soluble in water and in chloroform, and very slightly soluble in sodium hydroxide.

Nadolol tablets are available for oral administration as 20 mg, 40 mg and 80 mg tablets. Inactive ingredients: lactose monohydrate, microcrystalline cellulose, pregelatinized starch, croscarmellose sodium, hydroxypropyl cellulose, silicon dioxide, magnesium stearate, and purified water.

Nadolol Manufacturers

  • Rebel Distributors Corp
    Nadolol Tablet [Rebel Distributors Corp]
  • Udl Laboratories, Inc.
    Nadolol Tablet [Udl Laboratories, Inc.]
  • Dispensing Solutions, Inc.
    Nadolol Tablet [Dispensing Solutions, Inc.]
  • Rebel Distributors Corp
    Nadolol Tablet [Rebel Distributors Corp]
  • Rebel Distributors Corp
    Nadolol Tablet [Rebel Distributors Corp]
  • Physicians Total Care, Inc.
    Nadolol Tablet [Physicians Total Care, Inc.]
  • Remedyrepack Inc.
    Nadolol Tablet [Remedyrepack Inc. ]
  • Teva Pharmaceuticals Usa Inc
    Nadolol Tablet [Teva Pharmaceuticals Usa Inc]
  • Sandoz Inc
    Nadolol Tablet [Sandoz Inc]
  • Mylan Pharmaceuticals Inc.
    Nadolol Tablet [Mylan Pharmaceuticals Inc.]
  • Bluepoint Laboratories
    Nadolol Tablet [Bluepoint Laboratories]
  • American Health Packaging
    Nadolol Tablet [American Health Packaging]
  • Greenstone Llc
    Nadolol Tablet [Greenstone Llc]
  • American Health Packaging
    Nadolol Tablet [American Health Packaging]
  • American Health Packaging
    Nadolol Tablet [American Health Packaging]

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