Drug interactions
Epinephrine racemic + Nadolol
Severity: Major
Epinephrine racemic 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
Nonselective beta-blockade leaves alpha-mediated vasoconstriction of epinephrine unopposed, which can cause severe hypertension with reflex bradycardia. Epinephrine's bronchodilating and cardiac effects may also be blunted, and anaphylaxis can be harder to treat.
What this interaction means in plain words
Epinephrine racemic 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.
Why it happens
Nonselective beta-blockade unmasks unopposed alpha-adrenergic vasoconstriction by epinephrine.
What to do
Monitor blood pressure and heart rate closely if epinephrine is needed, and be prepared to treat hypertension and bradycardia; glucagon may be considered for refractory anaphylaxis. Consider a cardioselective beta-blocker when long-term therapy allows.
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
Frequently asked questions
Can I take Epinephrine racemic with Nadolol?
MediHelp rates the interaction as major. Epinephrine racemic 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. Nonselective beta-blockade leaves alpha-mediated vasoconstriction of epinephrine unopposed, which can cause severe hypertension with reflex bradycardia. Epinephrine's bronchodilating and cardiac effects may also be blunted, and anaphylaxis can be harder to treat.
How serious is the interaction between Epinephrine racemic 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 if epinephrine is needed, and be prepared to treat hypertension and bradycardia; glucagon may be considered for refractory anaphylaxis. Consider a cardioselective beta-blocker when long-term therapy allows.
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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