Names and pronunciation
(nay-doe′lole) Corgard
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Drug reference
(nay-doe′lole) Corgard
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Func. class.: Antihypertensive, antianginal
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Chem. class.: β-Adrenergic receptor blocker
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ACTION: Long-acting, nonselective β-adrenergic receptor blocking agent, blocks β1 in the heart and β2 in the lungs, uterus, and circulatory system; mecha- nism is similar to that of propranolol
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USES: Chronic stable angina pectoris, mild to moderate hypertension
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CONTRAINDICATIONS: Hyper- sensitivity to this product, cardiac failure, cardiogenic shock, 2nd-/3rd-degree heart block, bronchospastic disease, sinus bradycardia, HF, COPD, asthma Precautions: Pregnancy, breastfeeding, diabetes mellitus, renal disease, hyper- thyroidism, peripheral vascular disease, myasthenia gravis, major surgery, nonal- lergic bronchospasm
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Black Box Warning: Abrupt discontinua- tion, ischemic heart disease may be more severe Black Box Warning: Taper over 1-2 wk to discontinue product; do not stop abruptly, may worsen angina pectoris Black Box Warning: Abrupt discon- tinuation: can result in MI, myocardial is- chemia, ventricular dysrhythmias, severe hypertension; withdraw slowly by tapering over 1-2 wk; if symptoms return, restart • Pregnancy/breastfeeding: use only if benefits outweigh risk to fetus; discon- tinue product or breastfeeding, excreted in breast milk Black Box Warning: Not to discontinue abruptly; may cause life-threatening car- diac changes
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SIDE EFFECTS CNS: Depression, dizziness, fatigue, drowsiness CV: Bradycardia, hypotension, HF, pal- pitations, chest pain, peripheral isch- emia, flushing, edema, vasodilation
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INTERACTIONS Increase: orthostatic hypertension— MAOIs; monitor B/P Increase: peripheral ischemia—ergots, avoid if possible Increase: bradycardia—digoxin; moni- tor for bradycardia Increase: hypotension, bradycardia— cloNIDine, EPINEPHrine Increase: lack of stability of dose in diabetes—antidiabetics, insulin, dose may need to be changed Increase: hypotensive effects—amphet- amines, methylphenidate, other antihyper- tensives, antipsychotics (2nd generation), barbiturates, calcium channel blockers, PDE5 inhibitors, prostacyclin analogues, other hypotensive agents, phenothiazines, general anesthetics, monitor B/P, consider stopping nadolol before surgery Decrease: β-blocking effect—thyroid hormones Decrease: antihypertensive effect— NSAIDs, monitor B/P Drug/Herb Increase: orthostatic hypertension—dong quai, garlic, ginseng, yohimbe; avoid con- current use
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DOSAGE AND ROUTES Angina pectoris • Adult: PO 40 mg/day, increase by 40-80 mg q 3-7days; maintenance 40-240 mg/ day Hypertension • Adult PO 40 mg daily, increase by 40-80 mg until therapeutic response; mainte- nance, 40-320 mg/day Renal dose • Adult: PO CCr 31-50 mL/min, give q24- 36hr; CCr 10-30 mL/min, give q24-48hr; CCr <10 mL/min, give q40-60hr
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Available forms: Tabs 20, 40, 80, 160 mg
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Administer: • With 8 oz water, check apical pulse before use; if <60 bpm, withhold; notify prescriber • Give without regard to food • Tabs may be crushed and mixed with food
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Assess: • Hypertension: check that prescriptions have been filled; Pulse, respirations dur- ing beginning therapy and periodically thereafter • Monitor for orthostatic hypotension • Angina: monitor frequency of angina, alleviating factors; duration, time started, activity being performed, character • Headache, light-headedness, de- creased B/P; may indicate a need for de- creased dosage • HF: daily weight, report gain of 2-3 lb/ wk or unexpected weight gain • Dyspnea: shortness of breath, wheez- ing, allergic rhinitis • I&O ratio, serum creatinine/BUN
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Evaluate: • Therapeutic response: decreased B/P, heart rate, symptoms of angina
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That product may mask signs of hypo- glycemia or alter blood glucose in pa- tients with diabetes • To avoid OTC products unless pre- scriber approves; to take as prescribed, at same time each day, do not double; to take missed dose as soon as remem- bered if less than 8 hr before next dose • To avoid hazardous activities if dizzi- ness occurs • Hypertension: to comply with com- plete medical regimen; to report weight gain of >5 lb, swelling, unusual bruising, bleeding • To rise slowly to prevent orthostatic hypotension • About how and when to check B/P, pulse; to hold dose, contact prescriber if pulse ≤60 bpm, systolic B/P <90 mm Hg
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PHARMACOKINETICS PO: Onset variable, peak 3-4 hr, duration 17-24 hr; half-life 20-24 hr; not metabo- lized; excreted in urine 70% (unchanged), bile, breast milk; protein binding 30%
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• Adult: PO 40 mg/day, increase by 40-80 mg q 3-7days; maintenance 40-240 mg/ day Hypertension
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• Adult: PO CCr 31-50 mL/min, give q24- 36hr; CCr 10-30 mL/min, give q24-48hr; CCr <10 mL/min, give q40-60hr
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