View source for Nadolol

{{drugbox
| verifiedrevid = 303331256
| IUPAC_name = (2''R'',3''S'')-5-{[(2''R'')-3-(''tert''-butylamino)-2-hydroxypropyl]oxy}-1,2,3,4-tetrahydronaphthalene-2,3-diol
| image = Nadolol.svg
| CASNo_Ref = {{cascite}}
| CAS_number = 42200-33-9
| ATC_prefix = C07
| ATC_suffix = AA12
| PubChem = 39147
| IUPHAR_ligand = 554
| DrugBank = APRD00301
| C = 17 |H = 27 |N = 1 |O = 4
|smiles = CC(C)(C)NC[C@@H](O)COc2cccc1C[C@@H](O)[C@@H](O)Cc12
| molecular_weight = 309.401 g/mol
| bioavailability = 
| protein_bound = 30%
| metabolism = Nil
| elimination_half-life = 14-24 hours
| excretion = [[Kidney|Renal]] and fecal (unchanged)
| pregnancy_AU = 
| pregnancy_US = C
| pregnancy_category = 
| legal_AU =
| legal_UK = POM
| legal_US = Rx-only
| legal_status = 
| routes_of_administration = Oral
}}

'''Nadolol''' ('''Corgard''', '''Anabet''', '''Solgol''', '''Corzide''', '''Alti-Nadolol''', '''Apo-Nadol''', '''Novo-Nadolol''') is a non-selective [[beta blocker]] used in the treatment of [[hypertension|high blood pressure]], [[Migraine|migraine headaches]], and [[angina pectoris|chest pain]].

==Chemistry==
Nadolol is polar and hydrophilic, with low [[lipid]] solubility.

==Pharmacology==

{{Main|Beta-blocker}}

Nadolol is a non-selective [[beta blocker]]; that is, it non-selectively blocks both [[beta-1 receptor|beta-1]] and [[beta-2 receptor]]s. It has a preference for beta-1 receptors, which are predominantly located in the [[heart]], thereby inhibiting the effects of [[catecholamine]]s and causing a decrease in [[heart rate]] and [[blood pressure]]. Its inhibition of beta-2 receptors, which are mainly located in the [[bronchus|bronchial]] [[smooth muscle]] of the [[airway]]s, leads to airway constriction similar to that seen in [[asthma]]. Inhibition of beta-1 receptors in the [[juxtaglomerular apparatus]] of the [[kidney]] inhibits the [[renin-angiotensin system]], causing a decrease in [[vasoconstriction]] and a decrease in water retention. Nadolol's inhibition of beta-1 receptors in the heart and kidney lead to its effects on lowering blood pressure.

The drug impairs [[atrioventricular node|AV node]] conduction and decreases [[sinoatrial node|sinus]] rate.

Nadolol may also increase [[blood plasma|plasma]] [[triglyceride]]s and decrease [[High density lipoprotein|HDL]]-[[cholesterol]] levels.

==Indications==

Nadolol is indicated for treatment of moderate [[hypertension]] and [[angina pectoris|chest pain]] and [[supraventricular tachycardia]]. In patients with severe [[hypertension]], nadolol can also treat [[tachycardia|reflex tachycardia]] due to treatment with vasodilators.  Nadolol and other non-selective beta-blockers are used in the prevention of rebleeding in the setting of bleeding secondary to [[portal hypertension]].

==Off-Label Uses==

A case report study from Harvard Medical School, published in 1991, described three adult patients with ADHD unsuccessfully treated with traditional psychostimulant (amphetamine) therapy due to lack of effectiveness or intolerance of the psychostimulant. Nadolol was then added to the psychostimulant therapy and the combination of medications resulted in improved attention and focus with decreased medication side effects. This suggested the combination of nadolol and the psychostimulant might be effective for treatment-resistant adults with ADHD.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1940895&dopt=Abstract]

==Contraindications==
Patients whose heart rate is largely mediated by the [[sympathetic nervous system]] (e.g. patients with [[congestive heart failure]] or [[myocardial infarction|myocardial infarct]]) should avoid nadolol as it inhibits sympathetic function. Nadolol is also contraindicated in patients with [[bradycardia]] (slow heart rate) because of its vasodilatory effects and tendency to cause bradycardia.

Because of its beta-2 activity, nadolol causes pulmonary bronchoconstriction and should be avoided in [[asthma]] patients in preference of a [[beta blocker|beta-1 blocker]]. (There may be new evidence indicating that long-term non-selective beta-blocker use may actually prove to be beneficial in mild asthma.<ref>http://ajrcmb.atsjournals.org/cgi/content/full/38/3/249</ref>)

As nadolol, like other beta-2 blockers, inhibits the synthesis and release of [[glucose]] in response to [[hypoglycemia]], it slows patients' recovery from acute hypoglycemic episodes and should be avoided in patients getting treatment for their diabetes mellitus. In patients with [[insulin]]-dependent diabetes, a selective beta-1 blocker is preferred over non-selective blockers.

==Side Effects==

* [[Bradycardia]]
* [[Fatigue (physical)|Fatigue]]
* [[Bronchospasm]]s

==See also==
* [[Renin-angiotensin system]]
* [[Anti-hypertensive]]
* [[Cardiology]]

==References==
{{Reflist}}
{{Note|bioavailability}} {{cite journal | author= Buice RG, Subramanian VS, Duchin KL, Uko-Nne S. | title=Bioequivalence of a highly variable drug: an experience with nadolol | journal=Pharmaceutical Research | volume=13 | issue=7 | year=1996 | pages=1109–15  | doi= 10.1023/A:1016031313065 | pmid= 8842054}}
^N. Hanania, S. Singh, R. El-Wali, et al. The safety and effects of the beta-blocker, nadolol, in mild asthma: An open-label pilot study
Pulmonary Pharmacology & Therapeutics, Volume 21, Issue 1, Pages 134-141

==External links==
* [http://lysine.pharm.utah.edu/netpharm/netpharm_00/druglist/nadolol.htm Nadolol], from the [[University of Utah]] School of Medicine

{{Endothelial antihypertensives}}
{{Adrenergics}}

[[Category:Beta blockers]]
[[Category:Phenol ethers]]
[[Category:Alcohols]]
[[Category:Tetralines]]

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