Presentation
A frequent conference presenter and speaker who is widely cited in the national media, he is past president of the Section on Clinical Child Psychology (the former Division 12) of the American Psychological Association, and of the International Society [books.google.com]
We present here the first case report of successful treatment of lithium-induced tremor with nadolol, which was selected because the patient had compromised liver function. The patient's liver function tests remained stable with the therapy. [ncbi.nlm.nih.gov]
Entire Body System
- Fatigue
Adverse Reactions: Bradycardia, dizziness, fatigue, cold extremities, heart failure, heart block, bronchospasm, GI upset, rash, pruritus. [empr.com]
Adverse reactions CNS: dizziness, fatigue, paresthesia, behavior changes, sedation CV: bradycardia, peripheral vascular insufficiency (Raynaud's phenomenon), heart failure EENT: blurred vision, dry eyes, nasal congestion GI: nausea, constipation, diarrhea [medical-dictionary.thefreedictionary.com]
Assess patient routinely for evidence of fluid overload (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention). Hypertension: Check frequency of refills to determine compliance. [nursing.unboundmedicine.com]
Some of the most common side effects include, but are not limited to: Slow heart rate (bradycardia) Cold, numb, and pale fingers and toes Dizziness Fatigue. [heart-disease.emedtv.com]
- Congestive Heart Failure
The rationale for this pilot study was based on the paradigm shift that was observed with the use of beta-blockers in congestive heart failure, which once contraindicated because of their acute detrimental effects, have now been shown to reduce mortality [ncbi.nlm.nih.gov]
Beta-blockers are known primarily for their reductive effect on heart rate, although this is not the only mechanism of action of importance in congestive heart failure. [en.wikipedia.org]
Nonallergenic bronchospasm, cerebrovascular insufficiency, well-compensated congestive heart failure (CHF), diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease. [rxlist.com]
Tell your doctor if you have asthma, chronic obstructive pulmonary disease, congestive heart failure, heart block, low heart rate, low blood pressure, impaired kidney function, diabetes mellitus, overactive thyroid, or peripheral vascular disease. [clevelandclinic.org]
- Asymptomatic
Hepatotoxicity Mild-to-moderate elevations in serum aminotransferase levels occur in less than 1% of patients on nadolol and are usually transient and asymptomatic, resolving even with continuation of therapy. [livertox.nih.gov]
Rhythm Monitoring and Stress Testing Prolonged or frequent monitoring may be necessary to reveal episodes of asymptomatic AF. [doi.org]
These patients are usually asymptomatic, and the liver functions return to baseline with the continuation of therapy. [ncbi.nlm.nih.gov]
Cardiovascular
- Hypertension
[…] system (SNS). beta-adrenergic antagonist An agent that binds to but does not activate beta -adrenergic receptors thereby blocking the actions of endogenous or exogenous beta -adrenergic agonists. beta -Adrenergic antagonists are used for treatment of hypertension [ebi.ac.uk]
2 hypertension. 1200 (See Table 1.) [drugs.com]
A beta-blocker drug, C 17 H 27 NO 4, used to treat hypertension and angina pectoris. nadolol [nad′ənol] a beta-adrenergic blocking agent. indications It is prescribed for long-term management of angina pectoris, for hypertension, and for migraine prophylaxis [medical-dictionary.thefreedictionary.com]
Nadolol is indicated for the management of hypertension and angina pectoris, and is used off label for prophylaxis against migraine and vascular headaches. [livertox.nih.gov]
Before the introduction of nadolol, propranolol was available for the treatment of systemic hypertension, angina pectoris, and adrenergically induced cardiac arrhythmias. [nejm.org]
- Heart Failure
Notify prescriber of heart rate below 55 beats/minute. • Assess for signs and symptoms of heart failure or bronchospasm. [medical-dictionary.thefreedictionary.com]
Adverse Reactions: Bradycardia, dizziness, fatigue, cold extremities, heart failure, heart block, bronchospasm, GI upset, rash, pruritus. [empr.com]
Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure, and should be used cautiously in the elderly and in patients with diabetes. [livertox.nih.gov]
[…] block greater than first degree. 600 a Cardiogenic shock. 600 a Overt heart failure. 600 a Warnings/Precautions Warnings Heart Failure Possible precipitation of heart failure. 600 a Avoid use in patients with overt heart failure; 600 a may use cautiously [drugs.com]
- Heart Disease
Overt heart failure. Cardiogenic shock. CHF. Boxed Warning: Exacerbation of ischemic heart disease following abrupt withdrawal. Warnings/Precautions: Ischemic heart disease. Bronchospastic disease, COPD. Renal or hepatic dysfunction. Diabetes. [empr.com]
Black Box Warnings May exacerbate ischemic heart disease following abrupt withdrawal Hypersensitivity to catecholamines has been observed during withdrawal Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuation [reference.medscape.com]
Apo-Nadolol tablets 40mg are also used for long-term management of angina (chest pain) in patients with heart disease; and control of most forms of arrhythmias (rapid or irregular heart beat). [inhousepharmacy.vu]
When discontinuing chronically administered nadolol, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. [drugs.com]
- Hypotension
Nadolol may reduce reflex orthostatic hypotension. [pdr.net]
Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates. [nursing.unboundmedicine.com]
Amphetamines, ephedrine, epinephrine, norepinephrine, phenylephrine, pseudoephedrine: severe vasoconstriction and bradycardia Antihypertensives, nitrates: additive hypotension Clonidine: increased hypotension and bradycardia Digoxin: additive bradycardia [medical-dictionary.thefreedictionary.com]
Common side effects of nadolol include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and, less commonly, severe hypotension, heart failure and bronchospasm. [livertox.nih.gov]
- Slow Pulse
Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs. [nursing.unboundmedicine.com]
Neurologic
- Dizziness
Side Effects Dizziness, drowsiness, weakness, and cough may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. [healthlinkbc.ca]
Medication may mask some signs of hypoglycemia, but dizziness and sweating may still occur. [nursing.unboundmedicine.com]
Adverse Reactions: Bradycardia, dizziness, fatigue, cold extremities, heart failure, heart block, bronchospasm, GI upset, rash, pruritus. [empr.com]
- Headache
[…] not activate beta -adrenergic receptors thereby blocking the actions of endogenous or exogenous beta -adrenergic agonists. beta -Adrenergic antagonists are used for treatment of hypertension, cardiac arrhythmias, angina pectoris, glaucoma, migraine headaches [ebi.ac.uk]
Nadolol is indicated for the management of hypertension and angina pectoris, and is used off label for prophylaxis against migraine and vascular headaches. [livertox.nih.gov]
Currents and as an Associate Editor of Headache ; he receives publishing royalties for Wolff's Headache, 8th edition (Oxford University Press, 2009) and Handbook of Headache (Cambridge University Press, 2010). [doi.org]
Mar 28, 2013 (Started Feb 26, 2013) Effectiveness Moderate (for postural orthostatic tachycardia syndrome) Side effects Severe (nausea and vomiting, shortness of breath (dyspnea), headaches) Burden Somewhat hard to take Dosage: 10 mg Daily Cost: < $25 [patientslikeme.com]
- Tremor
Lithium-induced tremor classically responds to treatment with propranolol. [ncbi.nlm.nih.gov]
Maximum benefit was achieved with a dose of 240 mg, when resting tremor improved 54%, postural tremor 32%, and intention tremor 54%. Physician ratings and patient reports supported the accelerometer results. [doi.org]
In this study, we evaluated the effect of a chronic administration of nadolol, a long-acting beta-blocker on the sympathetic symptoms (tachycardia, tremors, hyperhidrosis) and on the hormonal parameters in 10 patients with hyperthyroidism. [moh-it.pure.elsevier.com]
For the treatment of tremor†. For the treatment of essential tremor†. Oral dosage Adults In one placebo-controlled study, doses of 120 to 240 mg/day PO reduced essential tremor in patients who had previously responded to propranolol. [pdr.net]
Nadolol is also used for MIGRAINE DISORDERS and for tremor. [drugcentral.org]
- Vertigo
Common side effects of Corgard include: dizziness, drowsiness, weakness, fatigue, spinning sensation ( vertigo ), tired feeling, nausea, diarrhea, constipation, upset stomach, bloating, gas, and tingly feeling. [rxlist.com]
[…] blocking agents) Possible additive negative effects on SA or AV nodal conduction 116 117 Catecholamine-depleting drugs (e.g., reserpine) Potential for additive effects (increased hypotension and marked bradycardia) 600 a Monitor closely for symptoms (e.g., vertigo [drugs.com]
Patients treated concurrently with a beta-blocker and reserpine should be monitored closely for evidence of hypotension or marked bradycardia and associated symptoms (e.g., vertigo, syncope, postural hypotension). [pdr.net]
- Giddiness
Treatment-related AEs (rash, giddiness, sleepiness, and gastrointestinal intolerance) occurred in 10% of patients on lamotrigine. Oxcarbazepine. [doi.org]
Workup
As with any use of β-blocker therapy in a pediatric patient, a cardiac workup is advised before the start of nadolol therapy; blood pressure and heart rate monitoring should be performed at one and two hours after the first dose and continued during dose [ncbi.nlm.nih.gov]
Before the start of treatment with any β-blocker, it is mandatory to carry out a cardiac workup and to monitor the patient’s BP and HR one and two hours after the initial dose and throughout the course of dose escalation. [ajhp.org]
Serum
- Hypoglycemia
Beta-blockers can also mask signs of hypoglycemia, especially tachycardia, palpitations, and tremors; in contrast, diaphoresis and the hypertensive response to hypoglycemia are not suppressed with beta-blockade. [pdr.net]
Medication may mask some signs of hypoglycemia, but dizziness and sweating may still occur. [nursing.unboundmedicine.com]
• Tell diabetic patient and family that drug may mask hypoglycemia symptoms. [medical-dictionary.thefreedictionary.com]
Non selective beta blockers may also mask the symptoms of hypoglycemia. guanfacine nadolol, guanfacine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. [reference.medscape.com]
QRS Wave
- Wide QRS Complex
AF associated with rapid ventricular rates and a wide-complex QRS (aberrant conduction) may sometimes be mislabeled as ventricular tachycardia, and an electrophysiological study can help establish the correct diagnosis. [doi.org]
Blocks
- Third Degree Atrioventricular Block
Before using this medication, tell your doctor or pharmacist your medical history, especially of: certain types of heart rhythm problems (such as a slow heartbeat, second- or third-degree atrioventricular block) blood circulation problems (such as Raynaud's [healthlinkbc.ca]
Before using this medication, tell your doctor or pharmacist your medical history, especially of: certain types of heart rhythm problems (such as a slow heartbeat, second- or third-degree atrioventricular block), blood circulation problems (such as Raynaud's [webmd.com]
Treatment
It is also used in the prophylactic treatment of migraine, and as an adjunct in the treatment of hyperthyroidism. 2011-01-10 Nadolol is administered as an equimolar mixture of the four possible 2,3- cis -diastereoisomers of 5-[3-(tert-butylamino)-2-hydroxypropoxy [ebi.ac.uk]
Combination treatment attenuated this response and significantly reduced plasma aldosterone. Neither treatment had any effect on plasma noradrenaline levels. [ncbi.nlm.nih.gov]
Prognosis
A hemodynamic response to treatment is associated with a better long-term prognosis. [ncbi.nlm.nih.gov]
Atrial tachyarrhythmias after the maze procedure: incidence and prognosis. Circulation. 2004 ; 110 :II164–8. Link Google Scholar 71. Akar JG, Al-Chekakie MO, Hai A, et al.. [doi.org]
Etiology
Stable cirrhotic patients of mixed etiology underwent an intravenous glucose tolerance test and hyperinsulinemic-euglycemic clamp for the measurement of insulin secretion and insulin sensitivity (n = 16) and a 75-g oral glucose tolerance test (n = 17) [ncbi.nlm.nih.gov]
Introduction T hyrotoxicosis is a condition having multiple etiologies, manifestations, and potential therapies. [doi.org]
Epidemiology
Part 2, short-term reductions in blood pressure: an overview of randomized drug trials in their epidemiological context. Lancet. 1990; 335:827-38. http://www.ncbi.nlm.nih.gov/pubmed/1969567?dopt=AbstractPlus 107. Alderman MH. [drugs.com]
GLOSSARY AAN = American Academy of Neurology ; AE = adverse event ; CI = confidence interval ; ER = extended-release ; MAM = menstrually associated migraine ; PMP = perimenstrual period ; RCT = randomized controlled trial Epidemiologic studies suggest [doi.org]
Cancer Epidemiology. 38 (3): 279–85. doi:10.1016/j.canep.2014.03.011. PMID 24786858. ^ Kim HY, Jung YJ, Lee SH, Jung HJ, Pak K (2017). "Is Beta-Blocker Use Beneficial in Breast Cancer? A Meta-Analysis". [en.wikipedia.org]
Pathophysiology
The recent demonstration that beta blockers selectively blunt the increased morning risk of myocardial infarction suggests that these agents block the pathophysiologic consequences of stressors concentrated in the morning. [ncbi.nlm.nih.gov]
Scope of the Guideline e203 Background and Pathophysiology e204 2.1. Definitions and Pathophysiology of AF e205 2.1.1. AF Classification e206 2.1.1.1. Associated Arrhythmias e206 2.1.1.2. [doi.org]
Prevention
BACKGROUND/AIMS: beta-blockers effectively prevent first variceal bleeding (FVB) in cirrhotic patients. In patients with ascites, however, their use might be precluded by a high rate of contraindications and side effects. [ncbi.nlm.nih.gov]