A case report study from Harvard Medical School, published in 1991, described three adult patients with ADHD for whom traditional psychostimulant therapy (with methylphenidate) was either ineffective or wasn't well tolerated. Adding nadolol to the psychostimulant monotherapy resulted in improved attention and focus with decreased side effects. This suggested that combination therapy with nadolol and a psychostimulant (such as methylphenidate or dexamphetamine) might be effective for treatment-resistant ADHD in adults.
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 metoprolol in the prevention of breakthrough cardiac events while on therapy and is equivalent to propranolol. Nadolol has the advantage of once daily dosing and thus improved patient compliance.
Because of its beta-2 activity, nadolol causes pulmonary bronchoconstriction and should be avoided in asthma patients in preference of a beta-1 blocker. However, evidence from a 2008 study suggests that long-term non-selective beta-blocker use may actually prove to be beneficial in mild asthma.
Because nadolol, like other beta-2 blockers, inhibits the synthesis and release of glucose in response to hypoglycemia, it slows patients' recovery from acute hypoglycemic episodes and should be avoided in patients getting treatment for diabetes mellitus. In patients with insulin-dependent diabetes, a selective beta-1 blocker is preferred over non-selective blockers.
In a small study of 10 healthy individuals, green tea decreased the maximum plasma concentration and total concentration of Nadolol by over 85%. As such, it is suggested that green tea should be avoided when taking SLCO1A2 based drugs.
^Chockalingam, P; Crotti, L; Girardengo, G; Johnson, JN; Harris, KM; van der Heijden, JF; Hauer, RN; Beckmann, BM; Spazzolini, C; Rordorf, R; Rydberg, A; Clur, SA; Fischer, M; van den Heuvel, F; Kääb, S; Blom, NA; Ackerman, MJ; Schwartz, PJ; Wilde, AA (Nov 13, 2012). "Not all beta-blockers are equal in the management of long QT syndrome types 1 and 2: higher recurrence of events under metoprolol". Journal of the American College of Cardiology60 (20): 2092–9. doi:10.1016/j.jacc.2012.07.046. PMID23083782.Cite uses deprecated parameters (help)
^Condon, M. E.; Cimarusti, C. M.; Fox, R.; Narayanan, V. L.; Reid, J.; Sundeen, J. E.; Hauck, F. P. (1978). "Nondepressant .beta.-adrenergic blocking agents. 1. Substituted 3-amino-1-(5,6,7,8-tetrahydro-1-naphthoxy)-2-propanols". Journal of Medicinal Chemistry21 (9): 913. doi:10.1021/jm00207a014.edit
^Buice RG, Subramanian VS, Duchin KL, Uko-Nne S. (1996). "Bioequivalence of a highly variable drug: an experience with nadolol". Pharmaceutical Research13 (7): 1109–15. doi:10.1023/A:1016031313065. PMID8842054.
N. Hanania, S. Singh, R. El-Wali et al. "The safety and effects of the beta-blocker, nadolol, in mild asthma: an open-label pilot study". Pulmonary Pharmacology & Therapeutics21 (1): 134–141. doi:10.1016/j.pupt.2007.07.002.