Last update July 30, 2022

Nadolol

Limited compatibility

Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.

It is a nonselective beta-adrenergic antagonist used for the treatment of arrhythmias, angina pectoris, and hypertension. Oral administration once daily.

It is excreted in breast milk in a small amount, but which could be significant. (Fox 1985, Devlin 1981)

There are no published data on possible side effects in infants whose mothers were taking Nadolol.

Its low percentage of plasma protein binding make it likely that it would pass into breast milk in amounts which could be significant (Riant 1986), although its very wide volume of distribution would make it difficult.

Its low oral bioavailability makes it difficult for it to pass to the infant plasma from ingested breast milk, except in premature infants and in the immediate neonatal period in which there may be greater intestinal permeability.

Some authors consider it a safe medication during breastfeeding (Pringsheim 2012). American Academy of Pediatrics: medication usually compatible with breastfeeding. (AAP 2001)

Until more published data is known about this drug in relation to breastfeeding, known safer alternatives are preferable (Davanzo 2014, Mahadevan 2006), especially during the neonatal period and in the event of prematurity.

Alternatives

  • Metoprolol (Safe substance and/or breastfeeding is the best option.)
  • Propranolol (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Nadolol in other languages or writings:

Tradenames

Main tradenames from several countries containing Nadolol in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 30 (20 - 40) %
Molecular weight 309 daltons
Protein Binding 25 - 30 %
VD 2.2 (1.5 - 3.6) l/Kg
pKa 13.6 -
Tmax 2 - 4 hours
20 - 24 hours
M/P ratio 4.6 -
Theoretical Dose 0.05 mg/Kg/d
Relative Dose 5 (4 - 7) %
Ped.Relat.Dose 2 - 10 %

References

  1. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  2. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012 Abstract Full text (in our servers)
  3. Tamargo Menéndez J, Delpón Mosquera E. Farmacología de los bloqueantes de los receptores β-adrenérgicos. Curso βeta 2011 de Actualización en Betabloqueantes. 2011 Full text (in our servers)
  4. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  5. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  6. Riant P, Urien S, Albengres E, Duche JC, Tillement JP. High plasma protein binding as a parameter in the selection of betablockers for lactating women. Biochem Pharmacol. 1986 Abstract
  7. Fox RE, Marx C, Stark AR. Neonatal effects of maternal nadolol therapy. Am J Obstet Gynecol. 1985 Aug 15;152(8):1045-6. Abstract
  8. Devlin RG, Duchin KL, Fleiss PM. Nadolol in human serum and breast milk. Br J Clin Pharmacol. 1981 Sep;12(3):393-6. Abstract Full text (link to original source)

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