Drug interactions
Epinephrine + Nadolol
Severity: Major
Epinephrine and Nadolol: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
In patients on non-selective beta blockers, epinephrine's beta-2 vasodilation is blocked, leaving unopposed alpha-mediated vasoconstriction. This causes severe hypertension with reflex bradycardia, and epinephrine may also be less effective for anaphylaxis or bronchospasm.
What this interaction means in plain words
Epinephrine and Nadolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Epinephrine belongs to Endocrine; Nadolol belongs to Cardiovascular.
Why it happens
Nadolol blocks beta-1 and beta-2 receptors, leaving epinephrine's alpha-adrenergic effects unopposed.
What to do
Monitor blood pressure and heart rate closely when epinephrine is given, including local anesthetic preparations. In anaphylaxis, still give epinephrine, and have glucagon available for refractory cases.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Nadolol
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Epinephrine with Nadolol?
MediHelp rates the interaction as major. Epinephrine and Nadolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. In patients on non-selective beta blockers, epinephrine's beta-2 vasodilation is blocked, leaving unopposed alpha-mediated vasoconstriction. This causes severe hypertension with reflex bradycardia, and epinephrine may also be less effective for anaphylaxis or bronchospasm.
How serious is the interaction between Epinephrine and Nadolol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure and heart rate closely when epinephrine is given, including local anesthetic preparations. In anaphylaxis, still give epinephrine, and have glucagon available for refractory cases.
What other medicines interact with Nadolol?
MediHelp also lists interactions of Nadolol with, for example, Acebutolol, Adrenaline-articaine, Amifostine. The full list is on the Nadolol page.
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