the package insert of the medicine Corgard. Active principles Nadolol.
Angina pectoris: CORGARD is indicated for the long-term treatment of patients with angina pectoris.
Arrhythmias, and Prolapse of the mitral valve: CORGARD is indicated in the treatment of tachyarrhythmias heart related with hyperstimulation of sympathetic and in the treatment of prolapse of the mitral valve.
Hypertension: CORGARD is indicated for the treatment of hypertension; you can use it alone or in association with other anti-hypertensive medications, especially thiazide diuretics.
Migraine: CORGARD is indicated for the prophylactic treatment of migraine. (The nadolol is not indicated for the treatment of migraine established.)
Hyperthyroidism (Thyrotoxicosis) : CORGARD is indicated for the symptomatic treatment of hyperthyroidism and to prepare pre-operative patients with hyperthyroidism for thyroidectomy. Must be used associated with the therapy antitireoidiana conventional.
When should I not use?
The nadolol is contraindicated in patients with bronchial asthma, sinus bradycardia, blockage of the conduction greater than first degree, cardiogenic shock, and heart failure manifests itself (see WARNINGS).
How to use?
The dosage should be individualized. CORGARD can be administered without a saving relationship with meals.
The usual starting dose is 4 mg of CORGARD once a day. The dosage may be increased gradually in increments of 40 to 😯 mg at intervals of 3 to 7 days.
The usefulness and safety in angina pectoris of dosage greater than 24 mg/day have not been established.
Arrhythmias, and Prolapse of the mitral valve
The initial dose is 4 mg once a day, which can be increased, if necessary, to 160 mg once a day. Smaller Doses have been shown to be effective in the control of the prolapse of the mitral valve. If you experience bradycardia, the dose should be reduced to 40 mg once a day.
The initial dose is 4 mg of nadolol once daily, as single agent or associated with the diureticoterapia. The dose may be gradually increased in increments of 4O the 😯 mg to achieve a reduction in the optimal blood pressure. Doses up to 240 or 320 mg administered once a day may be necessary.
The starting dosage of CORGARD is 4TH to 😯 mg/day; maintenance dose is 80 to 160 mg/day.
Range of dosage : 80 – 160 mg/day. The nadolol should be administered in the morning at the time of surgery. In the postoperative period, the dosage of nadolol should be gradually reduced and then removed once the patient is stabilized.
Can be appropriate for a reduction in dosing to elderly patients, as renal function decreased is a consequence of physiological age.
The safety and effectiveness has not been established.
What are the evils that can cause me?
Bradycardia with heart rate less than 60 beats per minute occurs commonly, and heart rate below 40 beats per minute and/or symptomatic bradycardia were seen in about 2% of patients. Failure symptoms vasoperiférica, typically of the type raynaud’s occur in approximately 2% of patients. Heart failure, hypotension, and changes in heart rate occur in 1% of patients. The appearance of isolated heart block, first and third grade has been reported; intensification of AV block is a known effect of beta-blockers.
Central Nervous System
It is reported dizziness or fatigue in about 2% of patients; paresthesias, sedation, and change of behavior were each reported in about 0.6% of the patients.
It is reported bronchospasm in approximately 0.1% of patients.
Nausea, diarrhea, abdominal discomfort, constipation, vomiting, indigestion, anorexia, edema, and flatulence were reported in 0.1 to 0.5% of patients.
Agranulocytosis, thrombocytopenia and purpura do not trombocitopênica.
Fever combined with irritation of the oropharynx, laringoespasmo, breathing difficulty.
Each of the following reactions were reported by 0.1 to 0.5% of patients : rash; pruritus; headache; mouth, eyes, or dry skin; impotence or decreased libido; facial swelling; weight increase; voice clear; cough; nasal obstruction; sweating; blurred vision; ringing in the ear. It is reported alopecia reversible rarely.
The events listed, the following also occurred with the administration of nadolol and/or other agents with beta-adrenergic blockers; however, it is not established no causal relationship to nadolol :
Central Nervous system – depression reversible progressing to catatonia, visual disturbances, hallucinations, syndrome of acute reversible characterized by disorientation of time and place, loss of recent memory, emotional lability, decreased sensory perception, and decreased performance on neuropsychological tests.
Gastrointestinal – arterial thrombosis mesenteric, ischemic colitis, elevation of liver enzymes.
Hematologic – agranulocytosis, thrombocytopenic purpura or non-trombocitopênica.
Allergic – the fever associated with the pain of throat and sore throat, laringoespasmo, breathing difficulty.
Various – eruptions penfigóides, reactions hypertensive patients with pheochromocytoma, sleep disorders, Peyronie’s disease.
Warnings and Precautions
what should I know before using?
Patients with a history of Heart Failure
The stimulation of the sympathetic can be a vital component of function support circulation in patients with congestive heart failure, and blocking the beta-adrenergic receptor can worsen the bankruptcy.
Although beta-blockers should be avoided in cases of heart failure manifest, they can be used cautiously, if necessary, in patients with a history of heart failure is well compensated, usually with digitalis and diuretics. Agents beta-adrenergic blockers do not nullify the inotropic effect of digitalis on the heart muscle.
Patients without a history of Heart Failure
Depression continuous myocardium with beta-blockers can, in some cases, result in heart failure. At the first signs or symptoms of heart failure imminent, the patient should be scanned or treated with diuretics, and the response must be strictly observed. If heart failure persists even with the scan, and urine output adequate, you must stop the administration of CORGARD (gradually, if possible).
the Exacerbation of Ischemic Disease Heart after abrupt termination of therapy
Notes-if you are hypersensitive to catecholamines in patients who interrupt therapy with beta-blockers; may occur exacerbation of the angina, hypertension and, in some cases, myocardial infarction after discontinuation sudden of therapy. To discontinue the administration of nadolol in patients who have received it chronically, especially those with ischemic disease of the heart; the dosage should be gradually reduced in the course of 1 to 2 weeks and the patient should be carefully monitored. If there is marked impairment of angina, or if there is development of heart failure, the administration of nadolol should be returned immediately (at least temporarily), and other measures appropriate for the control of unstable angina should be taken. Patients should be warned to not interrupting or descontinuarem therapy without medical advice. Due to the fact of disease of the coronary arteries is common, and there is the possibility of this not be detected, it may be prudent not to discontinue treatment abruptly even in patients being treated only for hypertension.
Bronchospasm non-allergic (p. ex., chronic bronchitis, emphysema)
In general, patients with diseases broncoespásticas should not receive beta-blockers, since these may inhibit bronchodilation produced by stimulation of endogenous or exogenous by catecholamines of the beta-2 receptors.
The blocking of beta-receptors interfere with the ability of the heart to respond to the stimulus-reflex and may increase the risks of general anesthesia and surgical procedures that result in hypotension or prolonged low cardiac output.
If possible, beta-blockers should be discontinued well before the time of surgery. In the event of an emergency surgery, the anesthesiologist should be informed if the patient is under therapy with beta-blockers.
An exception to the above paragraph refers to surgery of the thyroid Z (see INDICATIONS – Hyperthyroidism and DOSAGE AND ADMINISTRATION – Hyperthyroidism).
Diabetes and Hypoglycemia
Blocking the beta-adrenergic receptor can prevent the onset of signs or warning symptoms of hypoglycemia acute. This fact is especially important for diabetics labile. The beta-blockade also reduces the release of insulin in response to hyperglycemia; therefore, it may be necessary to adjust the dose of drugs antidiabéticas.
Blocking the beta-adrenergic receptor may mask certain clinical signs of hyperthyroidism (p. ex., tachycardia). Abrupt withdrawal of nadolol in patients with thyrotoxicosis can trigger a crisis tireotóxica.
what to do if someone use a larger amount than is recommended?
in Addition to gastric lavage, the following measures can be taken if necessary. in the determination of the duration of therapy and corrective, must be taken into account the action of long-term nadolol.
Bradycardia excessive – administer atropine (0.25 to 1.0 mg). if there is no response to the blocking vagal, you should administer with caution, isoproterenol.
heart Failure – scanning and diuretics. it is reported that the administration of glucagon may also be useful in this situation.
Hypotension – if fluid administration is ineffective, administer vasopressores, such as dopamine, dobutamine, levarterenol or isoproterenol. there is evidence that pharmacological that levarterenol (norepinephrine) is the drug of choice.
in Bronchospasm – administering a stimulating agent b2 and/or derivative of theophylline.
The nadolol can be removed from general circulation by hemodialysis.