How does this medication work? What will it do for me?

Nadolol belongs to the class of medications called beta-blockers. It is used to prevent symptoms of angina (chest pain) and to treat mild to moderate high blood pressure. It works by relaxing blood vessels and reducing the demands on the heart.

When used to treat high blood pressure, it may be used alone or in combination with other medications.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

40 mg
Each round, white, biconvex tablet, scored and identified "APO" over "N40" on one side, contains nadolol 40 mg. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, lactose monohydrate, magnesium stearate, and microcrystalline cellulose.

80 mg
Each round, white, biconvex tablet, scored and identified "APO" over "N80" on one side, contains nadolol 80 mg. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, lactose monohydrate, magnesium stearate, and microcrystalline cellulose.

160 mg
Each blue, capsule-shaped, biconvex tablet, scored and identified "APO 160" on one side, contains nadolol 160 mg. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, FD&C Blue No. 1, FD&C Blue No. 2, lactose monohydrate, magnesium stearate, and microcrystalline cellulose.

How should I use this medication?

The recommended adult dose of nadolol ranges from 40 mg to 320 mg in one daily dose, with or without food.

For the treatment of angina pectoris or high blood pressure, the recommended starting dose is 80 mg once daily. If the desired response is not achieved after one week, your doctor may increase the daily dose by 80 mg in weekly intervals (e.g., in Week 1, the dose is 80 mg; in Week 2, the dose is 160 mg; etc.).

The maximum recommended daily dose is 240 mg for treatment of angina pectoris and 320 mg for treatment of high blood pressure.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to nadolol or any ingredients of the medication
  • are being treated with anesthetics that reduce the function of the heart (e.g., ether)
  • are in cardiogenic shock
  • have a severely slow heart rate
  • have allergic rhinitis
  • have asthma or a history of obstructive airway disease
  • have right ventricular failure caused by pulmonary hypertension
  • have serious heart block
  • have uncontrolled congestive heart failure

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

The following side effects may go away as your body becomes used to the medication; contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • constipation
  • decreased sexual ability
  • diarrhea
  • dizziness or lightheadedness
  • drowsiness (slight)
  • headache
  • nausea or vomiting
  • nightmares and vivid dreams
  • stomach discomfort
  • stuffy nose
  • trouble sleeping
  • unusual tiredness or weakness

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • cold hands and feet
  • confusion (especially in seniors)
  • dizziness or lightheadedness when getting up from a lying or sitting position
  • signs of breathing problems (e.g., breathing difficulty or wheezing, shortness of breath)
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • signs of heart problems (e.g., fast, irregular heartbeat or pulse, chest pain, difficulty breathing)
  • skin rash
  • slow heartbeat (especially less than 50 beats per minute)
  • swelling of ankles, feet, or lower legs

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • chest pain
  • signs of a serious allergic reaction (i.e., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Breathing problems: Nadolol may make symptoms of asthma and certain other breathing problems worse. If you have asthma, other breathing problems, or a history of breathing problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Diabetes: The signs of low blood sugar may not be as noticeable when taking nadolol. If you have diabetes and take insulin or other medications that work by reducing the insulin in the blood, monitor your blood sugar regularly while taking this medication.

Dizziness: Nadolol may cause dizziness, especially when this medication is first being started. Move slowly when changing from a lying or sitting position to a standing position to reduce the severity of dizziness.

Heart failure: If you have a history of heart failure or heart disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Hyperthyroidism (high level of thyroid hormones): Nadolol may reduce the symptoms of hyperthyroidism, giving a false impression that the condition is improving. If you have hyperthyroidism, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: If you have kidney disease or reduced kidney function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Mental health: If you have a history of depression or other psychiatric illness, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Myasthenia gravis: The signs of worsening myasthenia gravis may not be as noticeable for people taking nadolol. If you have myasthenia gravis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Peripheral vascular disease: Nadolol may worsen the symptoms of diseases of the blood vessels, such as Raynaud's disease. If you have a condition involving the blood vessels, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Psoriasis: Nadolol has been related to the development or worsening of psoriasis, although how this occurs is not known. If you have psoriasis or a history of psoriasis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Severe allergies: Nadolol may make it more difficult to treat severe allergic reactions with epinephrine. If you have allergies that are severe enough to cause anaphylaxis (a severe allergic reaction where swelling of the face, lips, and throat make it difficult to breathe), talk to your doctor about what to do if you have an allergic reaction.

Stopping medication: The dose of nadolol should be gradually reduced, rather than stopped suddenly. There have been reports of severe worsening of angina, and of heart attack or abnormal heart rhythms occurring for people with angina pectoris who have stopped this medication without gradually reducing the dose. Discuss the risks and benefits of stopping nadolol with your doctor.

Surgery: If you are scheduled for surgery, inform all doctors involved in your care that you take nadolol. If it is planned surgery and it is necessary to stop taking nadolol before the surgery, it should be done gradually to reduce the risk of chest pain and increased blood pressure.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking nadolol, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: Seniors are at an increased risk of experiencing the side effects of nadolol. The starting dose and maximum daily dose may be lower for this population.

What other drugs could interact with this medication?

There may be an interaction between nadolol and any of the following:

  • alpha-1 blockers (e.g., doxazosin, prazosin, tamsulosin)
  • alpha-2 blockers (e.g., clonidine, dexmedetomidine, methyldopa)
  • amifostine
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, phentermine)
  • anesthetic agents
  • angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, ramipril)
  • angiotensin II receptor blockers (i.e., irbesartan, losartian, valsartan)
  • antidiabetes medications (e.g., insulin, glyburide)
  • asthma medications (e.g., formoterol, salbutamol, salmeterol)
  • azole antifungals (e.g., itraconazole, ketoconazole, posaconazole)
  • barbiturates (e.g., phenobarbital)
  • benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
  • beta-agonists (e.g., formoterol, salbutamol, salmeterol)
  • other beta-blockers (e.g., atenolol, metoprolol, propranolol)
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • carbamazepine
  • cyclosporine
  • digoxin
  • dipyridamole
  • disopyramide
  • dronedarone
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide)
  • donepezil
  • epinephrine
  • ergot alkaloids (e.g., dihydroergotamine, methysergide)
  • fentanyl
  • floctafenine
  • galantamine
  • ginger
  • ginseng
  • guanethidine
  • licorice
  • lidocaine
  • MAO inhibitors (e.g., phenelzine, moclobemide, selegiline)
  • methylphenidate
  • nefazodone
  • nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen)
  • norepinephrine
  • other blood pressure-lowering medications
  • pentoxifylline
  • phosphodiesterase-5-inhibitors (e.g., sildenafil, tadalafil)
  • protease inhibitors (e.g., nelfinavir, ritonavir, saquinavir)
  • reserpine
  • rituximab
  • rivastigmine
  • St. John's wort
  • theophylline
  • trazodone
  • yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.