SIDE EFFECTS
Most adverse effects have been mild and transient and
have rarely required withdrawal of therapy.
Cardiovascular: Bradycardia
with heart rates of less than 60 beats per minute occurs
commonly, and heart rates below 40 beats per minute and/or
symptomatic bradycardia were seen in about 2 of 100 patients.
Symptoms of peripheral vascular insufficiency, usually
of the Raynaud type, have occurred in approximately 2
of 100 patients. Cardiac failure, hypotension, and rhythm/conduction
disturbances have each occurred in about 1 of 100 patients.
Single instances of first degree and third degree heart
block have been reported; intensification of AV block
is a known effect of beta-blockers (see also CONTRAINDICATIONS,
WARNINGS, and PRECAUTIONS).
Central Nervous System: Dizziness
or fatigue has been reported in approximately 2 of 100
patients; paresthesias, sedation, and change in behavior
have each been reported in approximately 6 of 1000 patients.
Respiratory: Bronchospasm has
been reported in approximately 1 of 1000 patients (see
CONTRAINDICATIONS and WARNINGS).
Gastrointestinal: Nausea, diarrhea,
abdominal discomfort, constipation, vomiting, indigestion,
anorexia, bloating, and flatulence have been reported
in 1 to 5 of 1000 patients.
Miscellaneous: Each of the
following has been reported in 1 to 5 of 1000 patients:
rash; pruritus; headache; dry mouth, eyes, or skin; impotence
or decreased libido; facial swelling; weight gain; slurred
speech; cough; nasal stuffiness; sweating; tinnitus; blurred
vision. Reversible alopecia has been reported infrequently.
The following adverse reactions have been reported in
patients taking nadolol and/or other beta-adrenergic blocking
agents, but no causal relationship to nadolol has been
established.
Central Nervous System:
Reversible mental depression progressing to catatonia;
visual disturbances; hallucinations; an acute reversible
syndrome characterized by disorientation for time and
place, short-term memory loss, emotional lability with
slightly clouded sensorium, and decreased performance
on neuropsychometrics.
Gastrointestinal: Mesenteric
arterial thrombosis; ischemic colitis; elevated liver
enzymes.
Hematologic: Agranulocytosis;
thrombocytopenic or nonthrombocytopenic purpura.
Allergic: Fever combined
with aching and sore throat; laryngospasm; respiratory
distress.
Miscellaneous: Pemphigoid rash;
hypertensive reaction in patients with pheochromocytoma;
sleep disturbances; Peyronie's disease.
The oculomucocutaneous syndrome associated with the beta-blocker
practolol has not been reported with nadolol.
DRUG INTERACTIONS
When administered concurrently, the following drugs may
interact with beta-adrenergic receptor blocking agents:
Anesthetics, general: exaggeration of
the hypotension induced by general anesthetics (see WARNINGS:
Major Surgery).
Antidiabetic drugs (oral agents and insulin):
hypoglycemia or hyperglycemia; adjust dosage
of antidiabetic drug accordingly (see WARNINGS: Diabetes
and Hypoglycemia).
Catecholamine-depleting drugs (e.g., reserpine):
additive effect; monitor closely for evidence
of hypotension and/or excessive bradycardia (e.g., vertigo,
syncope, postural hypotension).
Response to Treatment for Anaphylactic Reaction:
While taking beta-blockers, patients with a history of
severe anaphylactic reaction to a variety of allergens
may be more reactive to repeated challenge, either accidental,
diagnostic, or therapeutic. Such patients may be unresponsive
to the usual doses of epinephrine used to treat allergic
reaction
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