nadolol
CLINICAL USE
Beta-adrenoceptor blocker:Hypertension Angina Arrhythmias Migraine Thyrotoxicosis
DOSE IN NORMAL RENAL FUNCTION
Hypertension: 80–240 mg per day Angina, arrhythmias, migraine: 40–160 mg dailyThyrotoxicosis: 80–160 mg daily
PHARMACOKINETICS
Molecular weight :309.4 %Protein binding :30 %Excreted unchanged in urine : 73 Volume of distribution (L/kg) :1.9half-life – normal/ESRD (hrs) :12–24/45 DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
20 to 50 : Start with low dose and increase according to response 10 to 20 : Start with low dose and increase according to response <10 : Start with low dose and increase according to response DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD :Dialysed. Dose as in GFR <10 : mL/min HD :Dialysed. Dose as in GFR <10 : mL/min HDF/high flux :Dialysed. Dose as in GFR <10 : mL/min CAV/VVHD :Dialysed. Dose as in GFR=10–20 mL/min IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs Anaesthetics: enhanced hypotensive effect Analgesics: NSAIDs antagonise hypotensive effectAnti-arrhythmics: increased risk of myocardial depression and bradycardia; increased risk of bradycardia, myocardial depression and AV block with amiodaroneAntidepressants: enhanced hypotensive effect with MAOIsAntihypertensives; enhanced hypotensive effect; increased risk of withdrawal hypertension with clonidine; increased risk of first dose hypotensive effect with post-synaptic alpha-blockers such as prazosinAntimalarials: increased risk of bradycardia with mefloquineAntipsychotics enhanced hypotensive effect with phenothiazines Calcium-channel blockers: increased risk of bradycardia and AV block with diltiazem; hypotension and heart failure possible with nifedipine and nisoldipine; asystole, severe hypotension and heart failure with verapamil Diuretics: enhanced hypotensive effect Moxisylyte: possible severe postural hypotensionSympathomimetics: severe hypertension with adrenaline and noradrenaline and possibly with dobutamineTropisetron: increased risk of ventricular arrhythmias – use with caution ADMINISTRATION
Reconstition
– Route
Oral Rate of Administration
–Comments
– OTHER INFORMATION
SPC guidelines for increasing dosing interval for patients with renal impairment may be impractical with respect to patient complianceUnlike most other beta-blockers, nadolol is not metabolised and is excreted unchanged mainly by the kidneys.
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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