Nadolol


Article Author:
Shwetha Gopal


Article Editor:
Pujyitha Mandiga


Editors In Chief:
Kranthi Sitammagari
Mayank Singhal


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
7/22/2019 11:04:45 AM

Indications

The FDA-labeled indications of Nadolol are:

Angina: Nadolol has approval for long-term use in angina pectoris. Nadolol showed significant symptomatic improvement in regards to exercise tolerance and duration of exercise and was more effective than propranolol in slowing heart rate at rest and during exercise.[1]

Hypertension: Nadolol is indicated as the second line in the treatment of hypertension. Nadolol should not be used as the first line in the treatment of hypertension, in the absence of indications to start beta-blockers. Nadolol can reduce blood pressure significantly with minimal cardio depressant effect.[2] Adding a diuretic can enhance the effectiveness of nadolol.[3]

Non-FDA approved:

Atrial fibrillation:

Nadolol can be used to attain heart rate control in the acute management of atrial fibrillation. Oral beta-blockers, including nadolol, is also widely used as the primary therapy for chronic atrial fibrillation. Nadolol also decreases relapse in patients with paroxysmal atrial fibrillation.[4]

Ventricular arrhythmias due to congenital long QT syndrome:

The AHA recommends the use of nadolol in patients with ventricular arrhythmias due to congenital long QT syndrome for the reduction of adverse cardiac events, syncope, and prevention of sudden cardiac death.[5]

Ventricular premature beat:

Nadolol is an option for the suppression of ventricular premature beats. This effect is due to bradycardia induced prolongation of RR interval.[6] It is more effective in patients with coronary artery disease than in patients without heart disease.[7]

Catecholaminergic polymorphic ventricular tachycardia:

Nadolol is effective in reducing the incidence and severity of ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. Nadolol is believed to reduce the ventricular arrhythmia by reducing the catecholamine effect on the beta receptor.[7] As a non-selective beta-blocker, nadolol prevents arrhythmia and cardiac arrest much more effectively compared to other beta-1 selective beta-blockers.[8][9]

Supraventricular tachycardia:

Nadolol is effective in the termination of acute onset supraventricular tachycardia, in those patients where vagal maneuver is not an option or failed and did not respond to adenosine.[10] Nadolol can potentially control the ventricular rate in patients with sustained response supraventricular tachycardia.[11]

Gastroesophageal variceal hemorrhage prophylaxis in patients with liver cirrhosis: Nadolol is used for the prevention and management of gastroesophageal varices and variceal hemorrhage in patients with liver cirrhosis.[12] Nadolol and other beta-blockers(e.g., propranolol) have shown to significantly reduce variceal rebleeding, reduce deaths from variceal hemorrhage and overall mortality.[13] Nadolol, in combination with isosorbide dinitrate, is very effective as prophylaxis in a patient with liver cirrhosis.[14] A multi-center trial proved that nadolol plus endoscopic variceal ligation (EVL) reduces the incidence of variceal rebleeding compared to EVL alone.[15]

Thyrotoxicosis:

Nadolol produces clinical improvement in patients with thyrotoxicosis, by reducing palpitations, nervousness, and tremor, among others. It produces this effect by reducing the level of free thyroid hormone in the bloodstream. It also reduces the T3 levels and increases the reverse T3 levels.[16]

Mechanism of Action

Nadolol is a synthetic non-selective beta-adrenergic receptor blocker and an inverse agonist.[17] It competitively blocks the beta1 receptors in the heart and vascular smooth muscles, thus inhibiting the effect of catecholamine on these receptors, without sympathomimetic or membrane-stabilizing properties causing negative inotropic and negative chronotropic properties. This effect on vascular smooth muscle causes a reduction in peripheral vascular resistance and thus decreases systolic and diastolic blood pressure at rest and during exercise.[18] Its antiarrhythmic property is because it impairs the conduction through the AV node and suppress automaticity and thus decreases heart rate, cardiac output at rest and on exercise. This agent’s inhibiting effect of beta-2 receptor in juxtaglomerular apparatus results in inhibition of production of renin and subsequent reduction of angiotensinogen, angiotensin II-dependent vasoconstriction, and aldosterone dependent water retention.

Administration

Nadolol administration is primarily oral. It comes in 20 mg, 40 mg, 80 mg, 160 mg, 240 mg, and 320 mg tablet formulation. Various animal studies in dogs and rabbits (Lee 1975) have shown that pharmacological half-life is 12 to 24 hours. It’s the inherently longer duration of action allows once-daily dosing and is as effective as propranolol with its traditional four times daily dosing.[19] Unlike other beta-blockers, nadolol gets renally excreted, and it undergoes its first-pass metabolism in the liver. But it has little to no effect on the CYP450 system, and hence rarely causes severe liver injury.

Also, nadolol reduces renal blood flow. Therefore, dosage intervals should require monitoring with creatinine clearance.[20] Dosage requires no modification for CrCl over 50 ml/min. Extend the dosage interval to 24 to 36 hours, 24 to 48 hours and 40 to 60 hours  for CrCl 31 to 49 ml/min/1.73 m2, 10 to 30ml/min/1.73 m2 and under 10 ml/min/1.73 m2 respectively.

In patients with angina pectoris and hypertension, according to the FDA, nadolol should be started as a 40 mg once daily oral formulation. It should be gradually increased in 40 to 80 mg increments to achieve the required therapeutic concentration and should be tailored based on the patient’s response.[21] Maximum dosage for hypertension and angina are 320 mg and 240 mg, respectively.

In patients with atrial fibrillation, the American Heart Association recommends an oral dosage range of 10 mg to 240 mg, to be tailored based on the patient’s response.[4] In patients with catecholaminergic polymorphic ventricular tachycardia, supraventricular tachycardia, and ventricular arrhythmia due to congenital long QT syndrome the American Heart Association recommends an oral dosage of 40 mg to 320 mg once a day.[22][23] In patients with ventricular tachyarrhythmia, the American Heart Association recommends a dosage of 160 mg for long-term control.[24]

For both primary and secondary prophylaxis in patients with gastroesophageal variceal hemorrhage, the initial dose is 40 mg per day. This dose can increase to up to 80 mg per day in patients with ascites and up to 160 mg per day in patients without ascites. In these patients, dosing should be gradually increased every 2 to 3 days to reach a maximum tolerated dose. Heart rate should be maintained at 55 to 60 bpm, and dosage should be stopped or decreased if the blood pressure drops below 90 mmHg.[25]

In patients with thyrotoxicosis, American thyroid association recommends an oral dosage of 40 to 160 mg.[26]

In patients with migraine, the American Academy of Neurology and American Headache Society recommends an oral dosage of 40 to 160 mg once a day for prophylaxis.[27]

Adverse Effects

Nadolol has been well-tolerated in most of the clinical studies with minimal side effects.[19] The adverse effects of nadolol are mainly because of its effect on the beta-2 receptors. There are no known reports of major organ injury from using nadolol. However, there has been evidence of a mild to moderate increase in liver enzymes, especially aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in select patient populations; this is because of the first-pass metabolism of nadolol in the liver. These patients are usually asymptomatic, and the liver functions return to baseline with the continuation of therapy. There is no evidence of nadolol causing clinically apparent liver injury, but this adverse effect can get aggravated when used in combination with other hepatotoxic drugs. Nadolol is safe for use in patients with cirrhosis for primary or secondary prophylaxis of varices without affecting the liver function.[28]

The most common adverse effect is drowsiness and insomnia. Some other common adverse effects of nadolol are as follows:

Cardiovascular:

  • AV block
  • Bradycardia
  • Hypotension
  • Raynaud phenomenon

Central Nervous System:

  • Dizziness
  • Depression
  • Memory loss

Gastrointestinal:

  • Hepatotoxicity
  • Weakness
  • Impotence

 Respiratory:

  • Cough
  • Bronchospasm

Severe hypotension, bronchospasm, and allergic reactions are some of the rare but life-threatening adverse effects, often necessitating immediate emergency treatment. Nadolol should not be withdrawn abruptly [US BOX WARNING] as it can cause rebound tachycardia, hypotension and or ischemia. It should be stopped gradually to avoid these complications.[29]

Contraindications

  1. Asthma/COPD: The effect of nadolol on the beta-2 receptors of bronchial lining prevents bronchodilation and increases airway resistance, which exacerbates the effect in patients with a bronchospastic disease like asthma, and thus causing wheezing and shortness of breath.[29]
  2. Sinus bradycardia: One of the known effects of nadolol is reducing the resting heart rate. In patients with low heart rate originating from sinus node dysfunction, nadolol can lead to further reduction of the rate unless a pacemaker is present.[30]
  3. Greater than first degree AV block: Nadolol reduces conduction through AV node, potentially causing an AV block. Thus, nadolol can lead to serious bradyarrhythmia in patients with partial or complete AV block. Use with other drugs that might impair AV nodal conduction can exacerbate AV blockage.[29]
  4. Cardiogenic shock: The combined effect of lowering the resting heart rate and increasing the AV nodal conduction delay can potentially aggravate the already reduced cardiac output in patients with cardiogenic shock.[29]
  5. Decompensated cardiac failure: Beta-blockers are a cornerstone in the long-term treatment of compensated chronic heart failure with reduced ejection fraction, as it reduces the detrimental effect of sympathetic drive on the heart. But nadolol is contraindicated in patients with uncompensated heart failure as these patients rely on catecholamines for sustaining their heart rate and cardiac output and nadolol in these patients can exacerbate the symptoms of heart failure.[29]
  6. Hypersensitivity to nadolol.
  7. Anesthetic agents that can cause myocardial depression
  8. Nadolol is considered a pregnancy category C drug. It has been shown to reduce birth weight in infants. It is also contraindicated postpartum as it is expressed in breast milk and has proved to induce hypotension and hypoglycemia in neonates and infants.

For managing hypertension during pregnancy, beta-blockers like labetalol is preferable to nadolol.[29]

Monitoring

Heart rate:

Heart rate should be maintained above 55 bpm in patients taking nadolol. The heart rate specifically requires monitoring while escalating the dose, where it can cause further bradycardia, and while withdrawing the medications, where it can cause rebound tachycardia.[30]

The blood pressure should be maintained above 90 mmHg systolic, especially while escalating and withdrawing the medication.[29]

Signs and symptoms of angina exacerbation: Abrupt withdrawal of nadolol can cause exacerbation or causing anginal symptoms as it can cause rebound tachycardia and cause reduced blood flow to the myocardial tissue. Abrupt withdrawal of nadolol can cause rebound tachycardia and reduced blood flow to the myocardial tissue. Hence it can increase the anginal symptoms in some patients.[29]

Toxicity

Most of the nadolol poisonings occur via intentional consumption of the tablet. There are no reports of significant toxicity in the literature.[19] Most cases of nadolol poisoning are mild. These patients can be observed in an emergency department for 4 hours and discharged if no signs of poisoning develop. If there is moderate to severe toxicity, early decontamination with activated charcoal can be used along with gastric lavage if significant ingestion is suspected. After stabilizing the patient for airway, breathing, and circulation, enhanced elimination with hemodialysis is possible considering the low volume of distribution and longer half-life of nadolol.[29]

Signs and symptoms of moderate to severe poisoning include severe hypotension, bradycardia, bronchospasm, heart failure, hypoglycemia, seizure, and coma. First maintaining a patent airway is essential. Use suction if necessary, attempt to maintain oxygen saturation above 90% and resort to endotracheal intubation if necessary. Continuously monitor the patient for pulmonary edema or signs of shock. There is no specific antidote for nadolol toxicity. However, for the treatment of hypotension, glucagon,[31] dopamine or sodium bicarbonate, followed by multiple IV boluses of epinephrine if former is not adequate, can be used. Glucagon increases cAMP via a non-catecholamine mechanism, and thus, it can produce both ionotropic and chronotropic effect. For bradycardia, atropine is the therapy of choice; if the heart rate remains low after that, then IV isoproterenol or cardiac pacing can be done.[29] Treat heart failure with cardiac glycosides and diuretics.[29] Treat bronchospasm with nebulized beta-agonists (albuterol). Please note that higher than normal or multiple doses may be necessary. [29] Treat beta-blocker induced anaphylaxis with a lower than usual dose of epinephrine as the unopposed alpha-receptor effect can cause coronary vasoconstriction and paradoxical hypertension.

Enhancing Healthcare Team Outcomes

Nadolol's primary use is in the treatment of angina and hypertension.[32][2]

While the drug is safe, its use still requires monitoring.

Healthcare workers, including physicians, nurses, and pharmacists, should be cautious while withdrawing or stopping the drug as it can cause life-threatening rebound hypotension, tachycardia, and signs and symptoms of angina. Nadolol should be used cautiously with diuretics as it can potentiate the effect of hypotension by nadolol [3]. It is worth noting that nadolol can enhance and potentiate the effect of neuromuscular blocking agent tubocurarine chloride. Improved treatment outcome with nadolol is achievable with enhanced team performance, by ordering appropriate follow-up, monitoring for signs of inadequate dosage or signs of toxicity.

To improve outcomes and lower morbidity, the pharmacist should educate the patient on medication compliance and avoiding the use of other drugs/herbs without consulting with the physician. The pharmacist should also perform medication reconciliation to monitor for any potential interactions, and report these to the rest of the healthcare team. Nursing staff will have more frequent contact with patients and can gauge the success of treatment as well as observe for adverse effects. These factors must get communicated to the prescribing physician for dose and/or drug changes to the therapy regimen. Nadolol therapy requires an interprofessional healthcare team approach, including physicians, specialists, specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results. [Level V]


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Nadolol - Questions

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A 63-year old patient comes with complaints of on and off palpitation for the past 3 days. His past medical history is significant for hypertension. His medications include Lisinopril. Blood pressure is 140/90mmHg, pulse rate of 120bpm, and respiratory rate of 20 cpm. Cardiovascular examination reveals an irregularly irregular heart sounds. Rest of the physical examination is normal. The laboratory investigation revealed atrial fibrillation on ECG while the echocardiography turns out to be normal. Which of the following medications is used for ventricular rate control in this patient?



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A 40-year-old patient comes for a routine follow-up. He is a known hypertensive on Chlorthalidone. Blood pressure is 160/90mmHg, heart rate of 70bpm, and respiratory rate of 20cpm. Physical examination is normal. Which of the following drugs antagonize both beta-1 and beta-2 receptors in the treatment of this patient?



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A 66-year-old patient comes to the office with complaints of chest pain. It is substernal in location and increases when he is doing his early morning jog and reduces when he sits down to rest. His past medical history includes hypertension and diabetes. His medications are Lisinopril and metformin. Physical examination is within normal limits. Which of the following medications can be given as once daily dosing in this patient?



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A 45-year-old caucasian male comes for routine follow up. His past medical history includes hypertension on Lisinopril. His blood pressure is 160/90mmHg; pulse rate is 50bpm, respiratory rate is 20cpm. His physical examination is within normal. His lab results are within normal limits except serum cholesterol level of 300mg/dl, and creatinine clearance of 60ml/min Which of the following condition makes Nadolol contraindicated in this patient?



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A 65-year-old male patient presents with complaints of chest pain for the past month. The patient describes the sensation as a 'pressure' in the precordium which increases on exertion and goes away with rest. His past medical history includes hypertension, diabetes, asthma, and hypercholesterolemia. His blood pressure is 150/90 mmHg, pulse rate 68 bpm, respiratory rate of 20/min. His medications are lisinopril, metformin, albuterol, aspirin, and a statin. On physical examination, S1 and S2 are heard without any murmurs or gallops. The chest is clear on auscultation. Which of the following is contraindicated in this patient?



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Nadolol is in which one of the following drug categories?



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A 28-year-old female comes to the emergency department with complaints of palpitations. It has been on and off since yesterday, occurring approximately thrice a day and is unrelated to exertion or rest. She has no significant past medical history and takes no medications. Her Temperature is 98.6 F (37 C), Blood pressure is 110/7 0mmHg, Pulse rate is 120 bpm, irregularly irregular and respiratory rate of 20/min. The patient appears anxious. Lungs are clear on auscultation. ECG shows no discernable P wave. Echocardiography is normal. The patient is started on nadolol. Blockade of which of the following receptor is responsible for rate control in this patient?



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A 65-year-old male presents to the emergency department with complaints of hematemesis since yesterday. He has vomited about 250 ml of blood. It does not contain any food particle and is not related to food intake. It is associated with weight loss, anorexia, and fatigue. His past medical history is significant for liver cirrhosis. He does not smoke but continues to drink 1 case of beer per day. Physical examination shows obvious ascites. The patient undergoes upper gastrointestinal endoscopy, which shows gastroesophageal hemorrhage on the lesser curvature of the stomach and is managed with endoscopic variceal ligation. The patient is currently stable. The patient is started on nadolol. Which of the following mechanism is primarily responsible for reducing portal venous pressure in patients taking nadolol?



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Nadolol - References

References

Weber MA,Schiffrin EL,White WB,Mann S,Lindholm LH,Kenerson JG,Flack JM,Carter BL,Materson BJ,Ram CV,Cohen DL,Cadet JC,Jean-Charles RR,Taler S,Kountz D,Townsend RR,Chalmers J,Ramirez AJ,Bakris GL,Wang J,Schutte AE,Bisognano JD,Touyz RM,Sica D,Harrap SB, Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. Journal of clinical hypertension (Greenwich, Conn.). 2014 Jan;     [PubMed]
Volicer L,Liang CS,Gavras H,Tifft CP,Kershaw GR,Gavras I,Griffith DL,Vukovitch R,Brunner HR, Effect of nadolol in treatment of hypertension. Journal of clinical pharmacology. 1979 Feb-Mar;     [PubMed]
January CT,Wann LS,Alpert JS,Calkins H,Cigarroa JE,Cleveland JC Jr,Conti JB,Ellinor PT,Ezekowitz MD,Field ME,Murray KT,Sacco RL,Stevenson WG,Tchou PJ,Tracy CM,Yancy CW, 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2;     [PubMed]
Al-Khatib SM,Stevenson WG,Ackerman MJ,Bryant WJ,Callans DJ,Curtis AB,Deal BJ,Dickfeld T,Field ME,Fonarow GC,Gillis AM,Granger CB,Hammill SC,Hlatky MA,Joglar JA,Kay GN,Matlock DD,Myerburg RJ,Page RL, 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2018 Oct 2;     [PubMed]
Pitzalis MV,Mastropasqua F,Massari F,Passantino A,Luzzi G,Forleo C,Rizzon P, Effects of nadolol and its combination with atrial pacing on rate-enhanced ventricular premature complexes. The American journal of cardiology. 1996 Nov 15;     [PubMed]
Pitzalis MV,Mastropasqua F,Massari F,Totaro P,Passantino A,Rizzon P, The effect of nadolol on heart rate and the standard deviation of the RR intervals. European heart journal. 1995 Feb;     [PubMed]
Leren IS,Saberniak J,Majid E,Haland TF,Edvardsen T,Haugaa KH, Nadolol decreases the incidence and severity of ventricular arrhythmias during exercise stress testing compared with β1-selective β-blockers in patients with catecholaminergic polymorphic ventricular tachycardia. Heart rhythm. 2016 Feb;     [PubMed]
Hayashi M,Denjoy I,Extramiana F,Maltret A,Buisson NR,Lupoglazoff JM,Klug D,Hayashi M,Takatsuki S,Villain E,Kamblock J,Messali A,Guicheney P,Lunardi J,Leenhardt A, Incidence and risk factors of arrhythmic events in catecholaminergic polymorphic ventricular tachycardia. Circulation. 2009 May 12;     [PubMed]
Olukotun AY,Klein GJ, Efficacy and safety of intravenous nadolol for supraventricular tachycardia. The American journal of cardiology. 1987 Aug 31;     [PubMed]
Chang MS,Sung RJ,Tai TY,Lin SL,Liu PH,Chiang BN, Nadolol and supraventricular tachycardia: an electrophysiologic study. Journal of the American College of Cardiology. 1983 Nov;     [PubMed]
Garcia-Tsao G,Sanyal AJ,Grace ND,Carey W, Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology (Baltimore, Md.). 2007 Sep;     [PubMed]
Hayes PC,Davis JM,Lewis JA,Bouchier IA, Meta-analysis of value of propranolol in prevention of variceal haemorrhage. Lancet (London, England). 1990 Jul 21;     [PubMed]
Merkel C,Marin R,Sacerdoti D,Donada C,Cavallarin G,Torboli P,Amodio P,Sebastianelli G,Bolognesi M,Felder M,Mazzaro C,Gatta A, Long-term results of a clinical trial of nadolol with or without isosorbide mononitrate for primary prophylaxis of variceal bleeding in cirrhosis. Hepatology (Baltimore, Md.). 2000 Feb;     [PubMed]
de la Peña J,Brullet E,Sanchez-Hernández E,Rivero M,Vergara M,Martin-Lorente JL,Garcia Suárez C, Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: a multicenter trial. Hepatology (Baltimore, Md.). 2005 Mar;     [PubMed]
Peden NR,Isles TE,Stevenson IH,Crooks J, Nadolol in thyrotoxicosis. British journal of clinical pharmacology. 1982 Jun;     [PubMed]
Khilnani G,Khilnani AK, Inverse agonism and its therapeutic significance. Indian journal of pharmacology. 2011 Sep;     [PubMed]
Hornung RS,Gould BA,Kieso H,Raftery EB, A study of nadolol to determine its effect on ambulatory blood pressure over 24 hours, and during exercise testing. British journal of clinical pharmacology. 1982 Jul;     [PubMed]
Heel RC,Brogden RN,Pakes GE,Speight TM,Avery GS, Nadolol: a review of its pharmacological properties and therapeutic efficacy in hypertension and angina pectoris. Drugs. 1980 Jul;     [PubMed]
Herrera J,Vukovich RA,Griffith DL, Elimination of nadolol by patients with renal impairment. British journal of clinical pharmacology. 1979;     [PubMed]
Whelton PK,Carey RM,Aronow WS,Casey DE Jr,Collins KJ,Dennison Himmelfarb C,DePalma SM,Gidding S,Jamerson KA,Jones DW,MacLaughlin EJ,Muntner P,Ovbiagele B,Smith SC Jr,Spencer CC,Stafford RS,Taler SJ,Thomas RJ,Williams KA Sr,Williamson JD,Wright JT Jr, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2018 May 15;     [PubMed]
Turner GG,Nelson RR,Nordstrom LA,Diefenthal HC,Gobel FL, Comparative effect of nadolol and propranolol on exercise tolerance in patients with angina pectoris. British heart journal. 1978 Dec;     [PubMed]
Al-Khatib SM,Stevenson WG,Ackerman MJ,Bryant WJ,Callans DJ,Curtis AB,Deal BJ,Dickfeld T,Field ME,Fonarow GC,Gillis AM,Granger CB,Hammill SC,Hlatky MA,Joglar JA,Kay GN,Matlock DD,Myerburg RJ,Page RL, 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart rhythm. 2018 Oct;     [PubMed]
Page RL,Joglar JA,Caldwell MA,Calkins H,Conti JB,Deal BJ,Estes NA 3rd,Field ME,Goldberger ZD,Hammill SC,Indik JH,Lindsay BD,Olshansky B,Russo AM,Shen WK,Tracy CM,Al-Khatib SM, 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016 Apr 5;     [PubMed]
Nademanee K,Schleman MM,Singh BN,Morganroth J,Reid PR,Stritar JA, Beta-adrenergic blockade by nadolol in control of ventricular tachyarrhythmias. American heart journal. 1984 Oct;     [PubMed]
Garcia-Tsao G,Abraldes JG,Berzigotti A,Bosch J, Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology (Baltimore, Md.). 2017 Jan;     [PubMed]
Ross DS,Burch HB,Cooper DS,Greenlee MC,Laurberg P,Maia AL,Rivkees SA,Samuels M,Sosa JA,Stan MN,Walter MA, 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid : official journal of the American Thyroid Association. 2016 Oct;     [PubMed]
Silberstein SD,Holland S,Freitag F,Dodick DW,Argoff C,Ashman E, Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;     [PubMed]
Merkel C,Sacerdoti D,Finucci GF,Zuin R,Bazzerla G,Bolognesi M,Gatta A, Effect of nadolol on liver haemodynamics and function in patients with cirrhosis. British journal of clinical pharmacology. 1986 Jun;     [PubMed]
Nadolol (Corgard) - a new beta-blocker. The Medical letter on drugs and therapeutics. 1980 Apr 18;     [PubMed]
Hitzenberger G, Initial experience with a new long-acting beta-blocker, nadolol, in hypertensive patients. The Journal of international medical research. 1979;     [PubMed]
Ehgartner GR,Zelinka MA, Hemodynamic instability following intentional nadolol overdose. Archives of internal medicine. 1988 Apr;     [PubMed]
Burr DC,Ross J, How does binocular delay give information about depth? Vision research. 1979;     [PubMed]

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The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of PA-Hospital Medicine. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for PA-Hospital Medicine, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in PA-Hospital Medicine, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of PA-Hospital Medicine. When it is time for the PA-Hospital Medicine board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study PA-Hospital Medicine.