Nadolol (Corgard) is a non-selective beta blocker used in the treatment of high blood pressure and chest pain. Additionally, it is often prescribed in the treatment of atrial fibrillation, migraine headaches, and complications of cirrhosis. Nadolol is one of the preferred beta-blockers in the management of patients with LQTS for shortening of the QT interval and prevention of ventricular arrhythmia. It is more efficacious than cardioselective beta-blockers like metoprolol and propanolol in the prevention of breakthrough cardiac events Nadolol is a non-selective beta blocker; that is, it non-selectively blocks both beta-1 and beta-2 receptors. It has a preference for beta-1 receptors, which are predominantly located in the heart, thereby inhibiting the effects of catecholamines and causing a decrease in heart rate and blood pressure. Its inhibition of beta-2 receptors, which are mainly located in the bronchial smooth muscle of the airways, leads to airway constriction similar to that seen in asthma. Inhibition of beta-1 receptors in the juxtaglomerular apparatus of the kidney inhibits the renin–angiotensin system, causing a decrease in vasoconstriction and a decrease in water retention. For a comparison of propranolol and nadolol pharmacokinetics and clinical effects, 20 newly diagnosed patients with thyrotoxicosis were randomly selected to receive as sole therapy, either propranolol, 40 mg every 6 hours for 14 days, or nadolol, 80 mg each morning for 14 days. The study was repeated when the patients were in the euthyroid state. There was a similar and highly significant degree of beta blockade and amelioration of symptoms of thyrotoxicosis at the end of the dosage interval (trough), i.e., 24 hours after nadolol or 6 to 8 hours after propranolol. Trough and peak serum levels of propranolol were significantly lower when the patients were in a thyrotoxic state than when they were in a euthyroid state, whereas the pharmacokinetics of nadolol were not appreciably altered by thyrotoxicosis. In thyrotoxicosis, trough levels of propranolol and nadolol were significantly inversely correlated with derived creatinine clearance values. In the symptomatic treatment of thyrotoxicosis, nadolol, a once-daily nonmetabolized beta blocker, has certain advantages compared with propranolol. It is preferred by patients, is more convenient, and probably aids compliance.
Am Heart J. 1984 Oct;1084 Pt 21160-7. A comparison of propranolol and nadolol pharmacokinetics and clinical effects in thyrotoxicosis. Wilkinson R, Burr WA. For a comparison of propranolol and nadolol pharmacokinetics and clinical effects, 20 newly diagnosed patients with thyrotoxicosis were randomly selected to.