Non-selective β-blocker Pregnancy: There are no adequate and well-controlled studies in pregnant women. Nadolol should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus. In animal reproduction studies, embryo- and foetotoxicity was found in rabbits (but not rats or hamsters) at doses 5 to 10 times the maximum indicated human dose on a mg/kg basis; no teratogenic potential was observed. Foetal growth retardation has been reported. Neonates whose mothers received nadolol at parturition have exhibited bradycardia, hypoglycaemia, respiratory distress and associated symptoms. Breastfeeding: nadolol is excreted in human milk — decide whether to discontinue nursing or the drug, taking account of its importance to the mother. Fertility: no adverse effects in rat fertility and general reproductive performance studies; no other data available.

Nadolol

Brand names: Corgard

Nadolol is a long-acting, non-selective beta-adrenoceptor blocker used in hypertension, angina and certain arrhythmias, and in the prevention of variceal bleeding in portal hypertension.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Angina pectoris, cardiac tachyarrhythmias and migraine prophylaxis: initially 40 mg once daily. Hypertension: initially 80 mg once daily. Thyrotoxicosis: 80 to 160 mg once daily

Route: Oral

Frequency: Once daily, with or without regard to meals

Max: Angina pectoris: most patients respond to 160 mg or less daily — the value and safety of daily doses exceeding 240 mg have not been established. Hypertension: most patients respond to 240 mg or less daily, but higher doses have been required for a few patients. Cardiac tachyarrhythmias: may be increased if necessary to 160 mg once daily.

Source: UK SPC (eMC) for Nadolol 80 mg Tablets, §4.2 (https://www.medicines.org.uk/emc/product/12383/smpc). Dosage should be titrated gradually with at least a week between increments to assess response; individuals show considerable variation in their response to beta-adrenergic blockade. INDICATION-SPECIFIC TITRATION — Angina pectoris: initially 40 mg once daily, increased at weekly intervals until an adequate response is obtained or excessive bradycardia occurs. Hypertension: initially 80 mg once daily, increased by a weekly increment of 80 mg or less until an optimum response is obtained; many patients respond to 80 mg daily; a diuretic, peripheral vasodilator and/or other antihypertensive agents may be needed in conjunction; hypertension associated with phaeochromocytoma may require the addition of an alpha-blocking agent. Cardiac tachyarrhythmias: initially 40 mg once daily, increased if necessary to 160 mg once daily; if bradycardia occurs the dose should be reduced to 40 mg once daily. Migraine: initial dose 40 mg once daily, increased gradually in 40 mg increments until optimum prophylaxis is achieved; usual maintenance dose 80 to 160 mg once daily; if a satisfactory response is not obtained after 4 to 6 weeks at the maximum dose, withdraw nadolol gradually. Thyrotoxicosis: 80 to 160 mg once daily (most patients require 160 mg once daily); may be used with conventional anti-thyroid treatment; for preparation for partial thyroidectomy, give with potassium iodide for 10 days before operation and on the morning of operation, then reduce slowly post-operatively and withdraw following clinical stability. DISCONTINUATION: if nadolol is to be discontinued, reduce the dosage over a period of at least two weeks. ELDERLY: a low initial dose should be used so that sensitivity to side effects may be assessed. HEPATIC: patients with impaired renal or hepatic function should be monitored. PAEDIATRIC (non-numeric, so no structured paedDose): 'The safety and efficacy of nadolol in children has not been established.'

Dose adjustments

Renal

The dosage interval should be increased when creatinine clearance is below 50 ml/min/1.73 m2. As with all drugs, patients with impaired renal or hepatic function should be monitored. (No numeric revised interval is stated in the fetched §4.2.)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance, nadolol, or to any of the excipients (including previously demonstrated hypersensitivity to nadolol)
Bronchial asthma or a history of asthma
Sinus bradycardia
Greater than first degree atrioventricular conduction block
Cardiogenic shock
Right ventricular failure secondary to pulmonary hypertension
Overt cardiac failure

Side effects

Bradycardia (heart rate < 60 bpm; heart rate < 40 bpm and/or symptomatic bradycardia about 2%), cardiac failure, rate/rhythm and conduction disorders (about 1%) — common; first- and third-degree heart block reported (frequency unknown)
Symptoms of peripheral vascular insufficiency, usually of the Raynaud type (about 2%) and hypotension (about 1%) — common; cold extremities (frequency unknown)
Dizziness (about 2%) and fatigue (about 2%) — common; paraesthesia and sedation (about 0.6%), headache and slurred speech (0.1 to 0.5%) — uncommon
Bronchospasm (about 0.1%), cough and nasal stiffness (0.1 to 0.5%) — uncommon
Hypoglycaemia reported in neonates, infants, children, the elderly, patients on haemodialysis, patients on concomitant anti-diabetic therapy, those with prolonged fasting and those with chronic liver disease (frequency unknown); anorexia (0.1 to 0.5%)
Change in behaviour (about 2%), insomnia; gastrointestinal upset (nausea, diarrhoea, abdominal discomfort, constipation, vomiting, indigestion, bloating, flatulence, dry mouth 0.1 to 0.5%); rash, pruritus, dry skin, reversible alopecia; dry eyes and blurred vision; tinnitus; impotence or decreased libido

Interactions

eMC §4.5 was NOT retrieved in this bundle — the interactions below are from the US label in this bundle and must be checked against the UK SPC §4.5
General anaesthetics — exaggeration of the hypotension induced by general anaesthetics (US label)
Antidiabetic drugs (oral agents and insulin) — hypoglycaemia or hyperglycaemia; adjust the dose of the antidiabetic drug accordingly (US label)
Catecholamine-depleting drugs (e.g. reserpine) — additive effect; monitor closely for hypotension and/or excessive bradycardia (vertigo, syncope, postural hypotension) (US label)
Digitalis glycosides — both slow atrioventricular conduction and decrease heart rate; concomitant use can increase the risk of bradycardia (US label)
Adrenaline/epinephrine for anaphylaxis — patients on beta-blockers with a history of severe anaphylactic reaction may be more reactive to repeated allergen challenge and may be unresponsive to the usual doses of adrenaline used to treat an allergic reaction (US label)

Clinical monograph

How it works

It competitively blocks beta-1 and beta-2 adrenoceptors, reducing heart rate, myocardial contractility and conduction velocity, and lowering blood pressure; it is hydrophilic and largely excreted unchanged by the kidneys.

Prescribing in practice

As a non-selective beta-blocker it should be avoided in asthma and used with caution in chronic obstructive airways disease because of the risk of bronchospasm, and must not be stopped abruptly in ischaemic heart disease.
Its renal elimination means accumulation can occur in renal impairment, where dosing intervals may need adjustment.
It is contraindicated in marked bradycardia, high-grade heart block, uncontrolled heart failure and severe peripheral arterial disease; consult the SPC.

Monitoring

Monitor heart rate and blood pressure, and review renal function in patients with impaired kidneys.

Counselling the patient

Advise the patient never to stop the medicine suddenly because angina or blood pressure can worsen.
Warn those with asthma or wheeze to seek advice, and explain it may mask warning signs of low blood sugar in diabetes.

Evidence & guidelines

Nadolol is an established non-selective beta-blocker, also used for variceal bleeding prophylaxis; refer to current prescribing references.

Reference: NICE NG136; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Propranolol hydrochloride · Non-selective β-blocker

Pathways