Pharmacology of nadolol (SQ 11725), a beta-adrenergic antagonist lacking direct myocardial depression

A HPLC-MS/MS method for the determination of Nadolol in rat plasma: Development, validation, and application to pharmacokinetic study

A sensitive validated method has been developed for the quantification of Nadolol in rat plasma by high performance liquid chromatography coupled with tandem mass spectrometry (HPLC-MS/MS) using deuterated Nadolol (Nadolol D9) as internal standard (IS). The liquid-liquid extraction method using ethyl acetate was employed for the sample pretreatment. The separation was achieved on the Agilent Zorbax XDB C18 column (150  mm  ×  4.6  mm ID., 3.5  μm). The column temperature was controlled at 30°C. The components were eluted by using mobile phase A (10  mM ammonium formate) and mobile phase B (acetonitrile) in the ratio of 20:80  v/v with a flow rate of 0.5  mL/min. And 15  μL aliquot was injected in an isocratic elution mode with a total run time of 2.5  min. The multiple reactions monitoring transitions, m/z 310.20/254.10 for Nadolol and IS 319.20/255.00 were selected to achieve high selective analysis. The method exhibited great selectivity and linearity over the concentration range of 6 to 3000  ng/mL. The lower limit of quantification was found to be 6  ng/mL. The developed method proved acceptable results on selectivity, sensitivity, precision, accuracy, and stability studies as per Food and Drug Administration guidelines. This HPLC-MS/MS assay was successfully applied to get the pharmacokinetics parameters in rat plasma.

Oral Nadolol for the Treatment of Infantile Hemangiomas: A Single-Institution Retrospective Cohort Study

BACKGROUND

Beta-blockers have become the treatment of choice for problematic infantile hemangiomas (IHs). Nadolol, a nonselective beta-blocker with potential dosing advantages and a better safety profile than that of other beta-blockers, has been studied as an alternative therapeutic option. Our objective was to characterize the efficacy and safety of oral nadolol in the treatment of proliferating IHs.

METHODS

A retrospective cohort study was conducted at the Hospital for Sick Children between February 2010 and April 2012 in patients treated with nadolol for proliferating IHs causing functional impairment or cosmetic disfigurement. The primary outcome was the percentage involution measured independently by two assessors who scored changes in the extent of IHs by comparing serial photographs using a 100-mm visual analogue scale (VAS), on which 5 mm represented 10% change.

RESULTS

Forty-four patients treated with nadolol for IHs with adequate photographic documentation were identified. The median age at presentation was 4.5 months (interquartile range 1.5-7.9 mos). There was a mean improvement of 91.8 ± 11.1%. At least 50% improvement was noted in 42 (95%) patients and 75% improvement in 39 (89%) patients. The mean time to 50% and 75% improvement was 2.9 and 3.7 months, respectively. Analysis of variance showed that younger age at the time of treatment start was associated with a higher mean VAS score (% involution) (p < 0.05). Treatment duration (mean 9.5 ± 5.6 months) had no significant effect on VAS score. Test of interobserver correlation showed good agreement (intraclass correlation coefficient = 0.86, p = 0.001).

CONCLUSIONS

Oral nadolol is efficacious in patients with problematic IHs. Further large-scale prospective comparative studies are warranted to compare nadolol with other beta-blockers.

Beta(3)-adrenoceptors control Cl(-) conductance in rabbit nasal epithelium

We have investigated the effects of beta(3)-adrenoceptor stimulation in vivo on nasal epithelium. We have recorded the transepithelial potential difference in New Zealand white rabbit nostrils. Superfusion of the nasal epithelial surface with a Cl(-)-free medium supplemented with amiloride, hyperpolarized the nasal potential difference. Isoprenaline produced a hyperpolarization of the nasal potential difference that was not prevented by nadolol, a potent beta(1)-/beta(2)-adrenoceptor antagonist, but was abolished by bupranolol, a nonselective beta(1-3)-adrenoceptor antagonist. SR 58611 ((RS)-N-[(25)-7-ethoxycarbonylmethoxy-1,2,3,4-tetrahydronapht-2-yl]-(2R)-2-(3-chlorophenyl)-2 hydroethanamine hydrochloride) and CGP 12177 (4-[3-t-butylamino-2-hydroxypropoxy]benzimidazol-2-1), a preferential and a partial beta(3)-adrenoceptor agonists, respectively, also produced hyperpolarization of the nasal potential difference. SR 59230 (3-(2-ethylphenoxy)-1-[(1S)1,2,3,4-tetrahydronaphth-1-ylaminol]-(2S)-2-propanol oxalate), a selective beta(3)-adrenoceptor antagonist, abolished the effects of CGP 12177. We conclude that beta(3)-adrenoceptor stimulation resulted in modifications in the nasal potential difference. These findings strengthen the view that beta(3)-adrenoceptors are implicated in controlling water and salt transport in the normal respiratory epithelium.

Beta 3-adrenoceptor stimulation induces vasorelaxation mediated essentially by endothelium-derived nitric oxide in rat thoracic aorta

1. The relaxant effects of isoprenaline may result from activation of another beta-adrenoceptor subtype in addition to beta1 and beta2. This study evaluated the role of a third beta-adrenoceptor subtype, beta3, in beta-adrenoceptor-induced relaxation of rat thoracic aorta by isoprenaline. 2. Isoprenaline produced a concentration-dependent relaxation of phenylephrine pre-contracted rings of the thoracic aorta (pD2=7.46+/-0.15; Emax=85.9+/-3.4%), which was partially attenuated by endothelium removal (Emax=66.5+/-6.3%) and administration of the nitric oxide (NO) synthase inhibitor, L-NG-monomethyl arginine (L-NMMA) (Emax=61.3+/-7.9%). 3. In the presence of nadolol, a beta1- and beta2-adrenoceptor antagonist, isoprenaline-induced relaxation persisted (Emax=55.6+/-5.3%), but occurred at higher concentrations (pD2=6.71+/-0.10) than in the absence of nadolol and lasted longer. 4. Similar relaxant effects were obtained with two beta3-adrenoceptor agonists: SR 58611 (a preferential beta3-adrenoceptor agonist), and CGP 12177 (a partial beta3-adrenoceptor with beta1- and beta2-adrenoceptor antagonistic properties). SR 58611 caused concentration-dependent relaxation (pD2=5.24+/-0.07; Emax=59.5+/-3.7%), which was not modified by pre-treatment with nadolol but antagonized by SR 59230A, a beta3-adrenoceptor antagonist. The relaxation induced by SR 58611 was associated with a 1.7 fold increase in tissue cyclic GMP content. 5 Both relaxation and the cyclic GMP increase induced by SR 58611 were greatly reduced by endothelium removal and in the presence of L-NMMA. 6 We conclude that in the rat thoracic aorta, beta3-adrenoceptors are mainly located on endothelial cells, and act in conjuction with beta1- and beta2-adrenoceptors to mediate relaxation through activation of an NO synthase pathway and subsequent increase in cyclic GMP levels.

beta3-adrenoceptor control the cystic fibrosis transmembrane conductance regulator through a cAMP/protein kinase A-independent pathway

In human cardiac myocytes, we have previously identified a functional beta3-adrenoceptor in which stimulation reduces action potential duration. Surprisingly, in cardiac biopsies obtained from cystic fibrosis patients, beta3-adrenoceptor agonists produced no effects on action potential duration. This result suggests the involvement of cystic fibrosis transmembrane conductance regulator (CFTR) chloride current in the electrophysiological effects of beta3-adrenoceptor stimulation in non-cystic fibrosis tissues. We therefore investigated the control of CFTR activity by human beta3-adrenoceptors in a recombinant system: A549 human cells were intranuclearly injected with plasmids encoding CFTR and beta3-adrenoceptors. CFTR activity was functionally assayed using the 6-methoxy-N-(3-sulfopropyl)quinolinium fluorescent probe and the patch-clamp technique. Injection of CFTR-cDNA alone led to the expression of a functional CFTR protein activated by cAMP or cGMP. Co-expression of CFTR (but not of mutated DeltaF508-CFTR) with high levels of beta3-adrenoceptor produced an increased halide permeability under base-line conditions that was not further sensitive to cAMP or beta3-adrenoceptor stimulation. Patch-clamp experiments confirmed that CFTR channels were permanently activated in cells co-expressing CFTR and a high level of beta3-adrenoceptor. Permanent CFTR activation was not associated with elevated intracellular cAMP or cGMP levels. When the expression level of beta3-adrenoceptor was lowered, CFTR was not activated under base-line conditions but became sensitive to beta3-adrenoceptor stimulation (isoproterenol plus nadolol, SR 58611, or CGP 12177). This later effect was not prevented by protein kinase A inhibitors. Our results provide molecular evidence that CFTR but not mutated DeltaF508-CFTR is regulated by beta3-adrenoceptors expression through a protein kinase A-independent pathway.

Functional beta3-adrenoceptor in the human heart

Beta3-adrenoceptors are involved in metabolism, gut relaxation, and vascular vasodilation. However, their existence and role in the human heart have not been documented. We investigated the effects of several beta-adrenoceptor agonists and antagonists on the mechanical properties of ventricular endomyocardial biopsies. In the presence of nadolol, a beta1- and beta2-adrenoceptor antagonist, isoprenaline produced consistent negative inotropic effects. Similar negative inotropic effects also resulted from the action of beta3-adrenoceptor agonists with an order of potency: BRL 37344 > SR 58611 approximately CL 316243 > CGP 12177. The dose-response curve to BRL 37344-decreasing myocardial contractility was not modified by pretreatment with nadolol, but was shifted to the right by bupranolol, a nonselective beta-adrenoceptor antagonist. Beta3-adrenoceptor agonists also induced a reduction in the amplitude and an acceleration in the repolarization phase of the human action potential. Beta3-adrenoceptor transcripts were detected in human ventricle by a polymerase chain reaction assay. These results indicate that: (a) beta3-adrenoceptors are present and functional in the human heart; and (b) these receptors are responsible for the unexpected negative inotropic effects of catecholamines and may be involved in pathophysiological mechanisms leading to heart failure.

Biphasic antagonisms by beta-blockers against positive inotropic response through beta1-adrenoceptors in isolated canine right ventricular muscles: possible involvement of two beta 1-adrenoceptor subtypes

In isolated canine right ventricular muscles, we investigated the differences in antagonisms by beta-blockers against the positive inotropic effects (PIEs) of isoproterenol, a nonselective agonist, and T-0509, a beta1-selective agonist. The selective beta1-blockers atenolol and bisoprolol antagonized the PIE of T-0509 monophasically in Schild analysis, showing pA2 values of 7.05 and 7.63, respectively. On the other hand, both blockers produced biphasic antagonism against the PIE of isoproterenol (ISO); therefore, two pKB values were obtained (7.75 and 4.25 and 7.82 and 5.76, respectively). Nadolol, a nonselective beta-blocker, also antagonized the PIE of T-0509 monophasically (pA2 value 7.58), but antagonized the PIE of ISO biphasically (pKB values 7.42 and 4.39). Because the different mode of antagonism by three beta-blockers between T-0509 and ISO could not be explained by the selectivities of beta-agonists and blockers for beta1- and beta2-adrenoceptors in the heart, two subtypes of beta1-adrenoceptors may exist together in canine ventricular muscles, and atenolol, bisoprolol, and nadolol may act as antagonists for the two subtypes with two different affinities.

Characterization of propranolol-resistant (-)-[125I]-cyanopindolol binding sites in rat soleus muscle

1. The characteristics of a propranolol-resistant (-)-[125I]-cyanopindolol (CYP) binding site in rat soleus muscle were determined. 2. Saturation studies performed on homogenates of rat soleus muscle showed two phases of (-)-[125I]-CYP binding, a high affinity site (KD1 30.5 +/- 16.3 pM, Bmax 9.4 +/- 1.38 fmol mg-1 protein) and a lower affinity site (KD2 522.5 +/- 29.1 pM, Bmax 62.19 +/- 11.76 fmol mg-1 protein, n = 4). 3. In rat soleus muscle homogenates labelled with (-)-[125I]-CYP (500 pM), (-)-propranolol competition curves were biphasic with pKD values of 8.30 +/- 0.19, and 5.33 +/- 0.08, n = 7. 4. Competition between (-)-[125I]-CYP (500 pM) and (+/-)-tertatolol, (+/-)-nadolol, (+/-)-alprenolol, (+/-)-CYP, and (-) and (+)-pindolol showed that these compounds competed for binding at the propranolol-resistant site with affinities lower than those displayed at typical beta-adrenoceptors. The atypical beta-adrenoceptor agonists BRL 37344, SR58611A and ICI D7114 and the partial agonist (+/-)-CGP 12177 also competed for (-)-[125I]-CYP binding. 5. Stereoselectivity was demonstrated for the stereoisomers of alprenolol and tertalolol. The (-)-isomers of alprenolol and tertalolol had higher affinity than their corresponding (+)-isomers (3.1 and 2.6 fold respectively). These low stereoselectivity values are a characteristic of atypical beta-adrenoceptors. 6. The beta-adrenoceptor agonists, (-)-adrenaline, (-)-isoprenaline and (-)-noradrenaline, all showed lower affinity than the atypical beta-adrenoceptor agonists and competition curves appeared biphasic in nature. 7. These results confirm the presence of a propranolol-resistant (- )-[125I]-CYP binding site in rat soleus muscle. The affinities of the tested compounds at the propranolol-resistant (- )-[125I]-CYP binding site show similarities to their affinities at 'atypical' beta-adrenoceptors in adipocytes and gastrointestinal tissues and at the cloned beta 3-adrenoceptor.

Efficacy and safety of intravenous and oral nadolol for supraventricular tachycardia in children

The efficacy and safety of oral nadolol in supraventricular tachycardia were evaluated prospectively in 27 children (median age 5.5 years). Fifteen patients had an unsuccessful trial of digoxin therapy. Intravenous nadolol was given to seven patients during electrophysiologic study; five of these had an excellent response and two had a partial response (25% decrease in tachycardia rate). Six of these patients had a similar response to oral nadolol. Twelve patients received both propranolol and nadolol. Among six patients, intravenous propranolol was successful in four and unsuccessful in two; all six had a similar response to oral nadolol. With oral propranolol, tachycardia was well controlled in four patients and persistent in two; five of five patients had a similar response to oral nadolol. Twenty-six patients were treated with oral nadolol; the arrhythmia was well controlled in 23, 2 had recurrent tachycardia and 1 patient had tachycardia at a 25% slower rate. The effective dose of nadolol ranged between 0.5 and 2.5 mg/kg body weight once daily (median dose 1 mg/kg per day). During follow-up (3 to 36 months), compliance and tolerance were excellent; excluding 2 patients with reactive airway disease who developed wheezing, only 3 (12%) of 24 had side effects necessitating a change in drug therapy. Once a day nadolol is a safe and effective agent in the management of supraventricular tachycardia in children. Its long-term efficacy can be predicted by the short-term response to intravenous nadolol or propranolol during programmed electrophysiologic study.

Electrophysiological abnormalities and enhanced reperfusion arrhythmias in the isolated hearts of hyperthyroid rats

1. The influence of hyperthyroidism on electrophysiological characteristics and on reperfusion arrhythmias was examined in rat hearts. 2. Electrophysiological studies were performed with glass microelectrodes, and the experiments on reperfusion arrhythmias were done in isolated perfused hearts. 3. Ventricular muscle from hyperthyroid rats was more prone than that from euthyroid rats to develop triggered activity under conditions believed to cause myoplasmic Ca2+ overload. 4. The severity of reperfusion arrhythmias was significantly enhanced in hyperthyroid preparations as compared with euthyroid ones. 5. The enhanced reperfusion arrhythmias in hyperthyroid rats were significantly reduced by propranolol (3 x 10(-7) M), lignocaine (1 x 10(-5) M) and verapamil (3 x 10(-8) M), but not by nadolol (3 x 10(-7) M) or prazosin (3 x 10(-7) M). 6. These results suggest that increased heart rate due to hyperthyroidism and responses mediated via either alpha- or beta-adrenoceptors were not dominant causes of enhanced reperfusion arrhythmias in hyperthyroid hearts. 7. The increased tendency to develop triggered activity which was observed in the electrophysiological study, may be one possible explanation of enhanced reperfusion arrhythmias in hyperthyroid hearts.

Agonist and antagonist characterization of a putative adrenoceptor with distinct pharmacological properties from the alpha- and beta-subtypes

1. Experiments were done to characterize a putative adrenoceptor which functions to inhibit longitudinal muscle tension development in the guinea-pig ileum. Several phenylethylamine based agonists were investigated: BRL 37344, (-)-isoprenaline, (+)-isoprenaline, noradrenaline, adrenaline, and fenoterol. Propranolol and nadolol were tested as antagonists. Agonist-induced inhibition of the contractile response to histamine was measured under equilibrium conditions with alpha-adrenoceptors and muscarinic cholinoceptors inhibited. 2. Inhibitory responses were obtained to (-)-isoprenaline and BRL 37344 that were resistant to beta-adrenoceptor blockage with propranolol (5 microM) and nadolol (10 microM). These resistant responses were antagonized by much higher concentrations of nadolol (30 to 1000 microM) yielding apparent pA2 values for nadolol of 4.31 with (-)-isoprenaline as the agonist, and 4.68 with BRL 37344 as the agonist. Similar apparent pA2 values for nadolol at the putative adrenoceptor were obtained with noradrenaline (4.79), adrenaline (4.68), and fenoterol (4.38). 3. The order and relative potency of agonists at the putative adrenoceptor was: BRL 37344 (20) greater than (-)-isoprenaline (8) greater than noradrenaline (1) greater than adrenaline (0.5) greater than fenoterol (0.35) greater than (+)-isoprenaline (0.27). 4. The resistance to blockade by propranolol (5 microM), the low affinity of nadolol, and the order and relative potency of agonists, suggest the presence of an adrenoceptor with distinct pharmacological characteristics from currently defined alpha- and beta-adrenoceptors.

Comparison of the effects of acute and chronic beta-blockade on infarct size in the dog after circumflex occlusion

In order to compare the effects of acute and chronic beta-blockade on infact size, the left circumflex coronary artery was occluded for 6 hours in 33 anesthetized dogs. The dogs (18 to 22 kg) were divided into three groups; group 1 (N = 10) served as controls, group 2 received intravenous nadolol (average dose 1.25 mg/kg) just prior to coronary occlusion, and group 3 received oral nadolol (80 mg) twice daily for 16 days prior to coronary occlusion. To ensure equivalent degrees of beta-blockade at the time of occlusion, group 2 and 3 dogs were given incremental doses of intravenous nadolol to abolish the chronotropic response to isoproterenol (2 mu/kg IV). Left ventricular pressure, its first derivative (dP/dt), and heart rate were monitored. The anatomic risk region was determined antemortem by Evan's blue staining while the infarct zone was delineated postmortem by tetrazolium staining. Compared to Group 1, heart rate was 22% lower in group 2 and 15% lower in group 3 dogs 6 hours after occlusion (p less than 0.05). There were no differences among groups in peak left ventricular systolic pressure or mean arterial pressure. Infarct size as a function of the area at risk was 68 +/- 3% in group 1, 52 +/- 7% in group 2, and 44 +/- 8% in group 3. A significant difference was found only between groups 3 and 1. The data suggest that chronic beta-blockade provides greater protection against ischemic-induced necrosis than does acute beta-blockade. The greater protective effect of chronic beta-blockade may be due to chronic adaptive changes in either blood flow or metabolism.

Effect of propranolol on ventricular repolarization and refractoriness: role of beta-blockade versus direct membrane effects

The purpose of this study was to define the role of beta-adrenergic blockade and direct membrane effects in the ability of dl-propranolol to alter ventricular repolarization and refractoriness in the intact heart. The effective refractory period (ERP) and the local Q-T interval were measured at an epicardial site in the left ventricle in 14 open-chest dogs anesthetized with alpha-chloralose. Beta-adrenergic influences were eliminated in seven dogs (group 1) by stellate transection and nadolol (0.5 mg/kg IV), and enhanced in seven dogs (group 2) by stellate transection and stimulation of the left ansae subclavia. Each dog received an initial beta-blocking dose of propranolol (0.5 mg/kg) followed by a second, cumulative dose of 5.0 mg/kg. In group 1 dogs, there was no significant change in either the ERP or local Q-T interval in response to the first dose of propranolol. In group 2 dogs, left stellate stimulation significantly shortened the ERP (20 +/- 2 msec) and the local Q-T interval (17 +/- 4 msec). The first dose of propranolol prolonged these parameters to values not different from prestimulation control values. There was no change in the H-V interval, QRS complex duration, or diastolic threshold (DT) in either group after the initial propranolol dose. The second dose of propranolol significantly shortened the ERP (5 +/- 1 msec) and the local Q-T interval (11 +/- 2 msec) in both groups. This dose also significantly increased the DT, H-V interval, and QRS complex duration.(ABSTRACT TRUNCATED AT 250 WORDS)

Reduction in digitalis-associated postinfarction mortality with nadolol in conscious dogs

Previously, we have demonstrated an increased incidence of lethal ischemic arrhythmias in postinfarction dogs with clinically observable serum digoxin concentrations, and a significant reduction in digitalis-related lethal ischemic arrhythmias after subacute left stellectomy. In the present study, the protective actions of acute beta-adrenoceptor blockade with nadolol, 1.0 mg/kg administered intravenously immediately preceding the induction of posterolateral myocardial ischemia, were assessed in conscious dogs with recent, small anterior myocardial infarctions pretreated with digoxin, 0.0125 mg/kg/day intravenously, for 5 to 7 consecutive days (total n = 11). A cohort of postinfarction dogs pretreated with digoxin alone served as a control group (total n = 26). Pre vs postdigoxin electrophysiologic testing indicated reductions in myocardial refractoriness in ventricular noninfarct and infarct zones in both treatment groups, whereas the administration of nadolol tended to reverse the reductions in ventricular refractoriness. Arrhythmia-related deaths in response to posterolateral myocardial ischemia were reduced from 12 of 20 (60%) in the digoxin control group to 2 of 10 (20%) in the digoxin + nadolol group (p = 0.039). Serum digoxin concentrations (1.29 +/- 0.14 ng/ml vs 1.39 +/- 0.24 ng/ml), underlying anterior myocardial infarct size (6.9 +/- 1.5% vs 4.6 +/- 0.9% of left ventricle), and developing posterolateral myocardial infarct size (22.8 +/- 2.5% vs 17.5 +/- 3.6% of left ventricle) did not differ significantly between the digoxin and digoxin + nadolol groups. Acute beta-adrenoceptor blockade with nadolol appears to reduce digitalis-mediated ischemic postinfarction mortality, possibly because of a salutary increase in ventricular refractoriness.

A comparison of betaxolol and nadolol on renal function in essential hypertension

Betaxolol, a beta 1-selective adrenergic antagonist, and nadolol, a nonselective beta-adrenergic antagonist are both potent long-acting antihypertensive drugs. The effects of betaxolol on renal function have not been reported. The effects of nadolol on renal function are controversial. The current randomized double-blind study was designed to compare the effects of betaxolol and nadolol on glomerular filtration rate, assessed by creatinine and inulin clearances, and renal hemodynamics, assessed by p-aminohippurate clearance. Following a 4-week placebo run-in period, 15 patients with essential hypertension were randomized to a mean dose of 22 mg betaxolol for 12 weeks, and 12 patients with essential hypertension were randomized to a mean dose of 103 mg nadolol for 12 weeks. Results indicate that neither drug produced a clinically relevant effect on renal function. These findings are consistent with previously reported observations with other beta-adrenergic blocking drugs. We conclude that neither of the beta-adrenergic antagonists, betaxolol or nadolol, convey a specific renal pharmacologic advantage; both are equally efficacious and safe in the treatment of mild-to-moderate essential hypertension.

The effect of beta blockers on cardiac neural discharge associated with coronary occlusion in the cat

The effect of timolol on postganglionic cardiac sympathetic neural discharge, blood pressure, heart rate, and rhythm changes associated with acute coronary occlusion of the left anterior descending artery was examined and compared with the effects of the beta blockers practolol and metoprolol. Timolol (5 mg/kg, IV) was infused 15 minutes prior to coronary occlusion in cats anesthetized with alpha-chloralose. Control heart rate fell from 129 +/- 10 to 106 +/- 2 one minute prior to coronary occlusion and remained at 106 +/- 2 beats/minute in the minute prior to arrhythmia. Control blood pressure fell from 126 +/- 20 to 91 +/- 19 and stabilized at 99 +/- 19 mm Hg one minute prior to coronary occlusion. Mean time to arrhythmia and death was 4.7 +/- 2.3 and 68.0 +/- 51.0 minutes (P greater than .05 vs no drug), respectively. Three cats died and two were sacrificed six hours after coronary occlusion. Blood pressure fell to 86 +/- 20 mm Hg two minutes after coronary occlusion, rose to 95 +/- 23 mm Hg at ten minutes, and remained there for ten minutes. Timolol did not alter postganglionic cardiac sympathetic neural discharge prior to coronary occlusion. Two minutes after coronary occlusion, mean postganglionic cardiac sympathetic neural discharge was 128 +/- 27 and increased to 139 +/- 36 impulses/second (% control) 4 minutes after coronary occlusion. A similar trend was found for the data recorded in 15 nerves (eight cats) in which coronary occlusion was initiated without timolol. The data suggest that a difference exists among beta blockers because prior to coronary occlusion, the cardioselective drugs metoprolol (1, 5, and 10 mg/kg, IV) and practolol (8 mg/kg, IV) depressed postganglionic cardiac sympathetic neural discharge whereas noncardioselective timolol did not. Because all three beta blockers increased the times to arrhythmia and death (although the increase was significant only after metoprolol and practolol), the acute protective mechanism does not appear to be due primarily to a depression of spontaneous sympathetic neural discharge.

A response to isoprenaline unrelated to alpha- and beta-adrenoceptor agonism

The hypothesis that beta-adrenoceptor agonism might explain a reported lack of competitive antagonism between alpha 2-adrenoceptor antagonists and agonists of the phenylethylamine class was tested in the electrically field stimulated ileum of the guinea-pig. The beta-adrenoceptor agonist, isoprenaline, was used as the phenylethylamine and inhibition of 'twitch' response evoked by cholinergic stimulation was measured. In the presence of idazoxan (3 microM), to block inhibitory alpha 2-adrenoceptors, propranolol (0.1 to 5.0 microM) failed to act competitively toward isoprenaline. Isoprenaline responses totally resistant to inhibition by propranolol were obtained. As inhibitory alpha 1-adrenoceptors are absent from guinea-pig ileum, a recognition site distinct from the currently defined alpha- and beta-adrenoceptors is postulated. Agonism by phenylethylamine based agonists at this site may explain their inability to act competitively with alpha- and beta-adrenoceptor antagonists.

Electrophysiologic effects, clinical efficacy and safety of intravenous and oral nadolol in refractory supraventricular tachyarrhythmias

The electrocardiographic and electrophysiologic effects, clinical efficacy and safety of intravenous and oral nadolol therapy were examined in 34 patients with recurrent supraventricular tachyarrhythmias (SVT) undergoing electrophysiologic evaluation. Programmed electrical stimulation was performed in the control (drug-free) state, after infusion of intravenous nadolol (mean dose 0.09 +/- 0.03 mg/kg) and after chronic oral nadolol therapy in patients who responded to intravenous nadolol (mean dose 83 +/- 12 mg for 5 days). Intravenous nadolol administration prolonged mean sinus cycle length (p = 0.009), mean PR interval (p = 0.001) and mean AH interval (p = 0.001), with no significant electrophysiologic effects in the atrium, ventricle or accessory bypass tracts. Oral nadolol had similar electrocardiographic and electrophysiologic effects, but of lesser magnitude. Intravenous nadolol resulted in complete suppression of induced SVT in 78% of patients with sinus and atrioventricular nodal reentrant tachycardia and 11% of patients with atrioventricular (AV) reentrant tachycardia (p less than 0.001). Partial responses were frequent in intraatrial or AV reentrant tachycardia (37%). Oral nadolol suppressed induction of SVT in patients who responded to intravenous nadolol. Adverse reactions to intravenous and oral nadolol were infrequent--6% and 8%, respectively--and usually did not require drug withdrawal. Intravenous nadolol is highly effective in sinus and AV nodal reentrant tachycardia, and a successful electrophysiologic response to it predicts efficacy of long-term oral nadolol therapy. It has limited efficacy alone in AV reentrant tachycardia and should be considered in combination with other antiarrhythmic therapy in this type of SVT.

Cardiohemodynamic effects of nipradilol (K-351) in the dog: comparison with propranolol, nadolol and prazosin

The cardiohemodynamic effects of nipradilol (K-351) were studied in comparison with those of propranolol, nadolol and prazosin in anesthetized, open-chest dogs. All drugs were administered intravenously. Nipradilol produced dose-dependent decreases in systemic blood pressure (BP), heart rate (HR), venous return (VR) and cardiac output (COP), but virtually no change in right atrial pressure (RAP). Propranolol decreased HR, tended to decrease VR and COP and increased RAP, but produced no change in systemic BP. Nadolol also decreased HR, VR and COP and increased RAP, but did not change systemic BP. Prazosin decreased systemic BP, VR and COP and tended to decrease RAP, but scarcely affected HR. After propranolol or nadolol, nipradilol failed to reduce HR, but still produced definite decreases in systemic BP, VR and COP and a slight decrease in RAP. After prazosin, nipradilol still produced decreases in systemic BP, HR, VR and COP. These results suggest that nipradilol decreases VR and COP mainly by increasing venous capacitance through direct venodilator action and in part by increasing resistance to VR through beta-adrenoceptor blockade. This effect also appears to be responsible for its hypotensive effect.

Effects of bucumolol, nadolol and nifenalol on maximum upstroke velocity of action potential in guinea pig papillary muscles

The effects of bucumolol (BUC), nadolol (NAD) and nifenalol (NIF) on contractile forces and on action potentials (APs) were investigated in isolated guinea pig atrial and papillary muscles, respectively. Log 1/ED40 values for the negative inotropic effects of these drugs were 0.097, 10 and 0.74 mmol/l in this order. BUC (50 mumol/l), NAD (0.5 mmol/l) and NIF (0.2 mmol/l) produced about 60, 20 and 20% reduction of Vmax at 1 Hz. The frequency-dependent reductions at these and higher concentrations were greatest for BUC, intermediate for NAD and least for NIF. These potencies at certain frequencies were, as a whole, consistent with log P-potency relationship established in our previous papers (Harada et al. 1981; Ban et al. 1985). The reductions of Vmax in APs in response to premature stimuli during basic stimuli at the rate of 0.25 or 0.027 Hz decayed exponentially during diastolic intervals (DI). The time constants of these decay process (tau) estimated by linear and nonlinear regression analyses and by eye were 12.2-9.6 s for BUC (50-100 mumol/l) and 2.9-4.8 s for NAD (1-2 mmol/l) and 57-87 ms for NIF (0.2-1 mmol/l). In terms of the molecular weight (MW)-log tau relationship (Ban et al. 1985), these tau values are within the 95% fiducial limit for BUC and NAD and deviated from the lower fiducial limit for NIF. The frequency-dependent reductions of Vmax by these drugs were explained in terms of a function of tau and the intercept Ao. Based on the study made by Cohen et al.(ABSTRACT TRUNCATED AT 250 WORDS)

Antiarrhythmic and electrophysiologic actions of clofilium in experimental canine models

Clofilium was studied in three experimental models. In non-ischemic and chronically infarcted canine hearts, clofilium (0.5-2 mg/kg) produced a dose-dependent increase in electrical ventricular fibrillation threshold (VFT), but prolonged the effective refractory period (ERP) of normal myocardium in only the non-ischemic heart. When chronically infarcted hearts were subjected to programmed electrical stimulation, 1 mg/kg of clofilium inhibited the re-induction of either ventricular tachycardia or ventricular fibrillation in 5 of 6 animals and slowed the rate of the induced tachycardia in the sixth. Clofilium, however, failed to alter ventricular refractory periods of normal myocardium at either twice diastolic threshold current (176 +/- 5 ms control vs. 187 +/- 9 ms post-clofilium, P greater than 0.05) or at 10 mA (134 +/- 6 ms control vs. 137 +/- 13 ms post-clofilium, P greater than 0.05). In addition, chronic administration of clofilium (2 mg/kg, i.v., followed by 1 mg/kg every 12 h) was ineffective in decreasing mortality in a canine model of sudden coronary death. Of 10 saline-treated conscious animals subjected to an electrically-induced intimal lesion of the left circumflex coronary artery in the presence of a previous ischemic insult, all 10 died suddenly of ventricular fibrillation within 173 +/- 45 min after current application. Under similar conditions, 7 clofilium-treated animals died suddenly within 249 +/- 88 min (P greater than 0.05) after current application while 3 animals survived (P greater than 0.10). Clofilium did, however, elevate the effective refractory period in these animals (150 +/- 3 ms saline-treated vs. 195 +/- 7 ms clofilium-treated). It is concluded from our data that there is little relationship between clofilium's electrophysiologic actions in normal myocardium and antiarrhythmic effects. Furthermore, simple prolongation of refractoriness in normal non-ischemic myocardium may be insufficient for the prevention of ventricular fibrillation which develops in response to a transient ischemic event superimposed on a chronically injured myocardium.

Interactions of beta-adrenoceptor antagonists and thyroid hormones in the control of heart rate in the dog

Propranolol, sotalol and nadolol have been infused into conscious dogs, and doses at which the three drugs are equipotent as beta-adrenoceptor antagonists determined. In euthyroid dogs, sotalol was more effective at lowering heart-rate than an equivalent dose of propranolol, while an equivalent dose of nadolol was without effect. Hyperthyroidism potentiated the lowering of heart-rate by sotalol, but inhibited that by propranolol. The effect of sotalol on heart-rate was correlated with its prolongation of the Q-T interval of the ECG. That of propranolol was correlated with its prolongation of the P-R interval. Nadolol did not affect P-R interval or Q-T interval except at relatively high dosage. We conclude that the tachycardia of hyperthyroidism is not affected by blockade of beta-adrenoceptors and therefore that it is not mediated by adrenergic mechanisms. The effectiveness of propranolol and sotalol in lowering heart-rate must be due to actions peculiar to those drugs, and not to beta-adrenoceptor antagonism.

Estimation of cardiodepressant potency of nadolol, alprenolol, propranolol and pindolol, beta-blocking agents, in heart-lung preparation and blood-perfused excised papillary muscle preparation of the dog

Direct cardiodepressant potency of nadolol was determined by comparing its effect with those of alprenolol, propranolol and pindolol, in both heart-lung preparation and blood-perfused papillary muscle preparation of the dog. In the heart-lung preparation, mean 50% beta-blocking doses of the beta-blockers to inhibit the positive chronotropic action of isoproterenol were 3.75 micrograms for nadolol, 12.5 micrograms for alprenolol, 9.6 micrograms for propranolol and 1.6 micrograms for pindolol. Alprenolol and propranolol in a dose of 10 mg shifted the cardiac function curves rightward and downward, while nadolol and pindolol in the dose of 10 mg did not shift the cardiac function curves. In the blood-perfused papillary muscle preparation, mean 50% beta-blocking doses of the beta-blockers, administered i.v. to the donor dog, to inhibit the positive inotropic action of isoproterenol were 9.1 micrograms/kg for nadolol, 56.6 micrograms/kg for alprenolol, 68.3 micrograms/kg for propranolol and 8.1 micrograms/kg for pindolol. Nadolol did not depress the contractile force in doses up to 1 mg/kg given i.v. or doses up to 10 mg given intra-arterially (i.a.) close to the preparation. Alprenolol and propranolol exerted the dose-related negative inotropic effects, when larger doses (30-300 micrograms) were injected i.a. Thus, it is confirmed that nadolol virtually possesses no direct cardiodepressant activity and also that the depressant activity is exerted only by large doses of the other beta-blockers.

Positive inotropic and toxic effects of brevetoxin-B on rat and guinea pig heart

Brevetoxin-B (GbTX-B), a cyclic polyether purified from the marine dinoflagellate Gymnodinium breve, produced positive inotropic and arrhythmogenic effects on isolated rat and guinea pig cardiac preparations at concentrations between 1.25 X 10(-8) and 1.87 X 10(-7) M. The toxin (10(-7) M) transiently increased left ventricular +dP/dt, hydraulic work, and oxygen consumption of paced working rat hearts, then reduced these variables during continuous exposure. Brevetoxin-B exerted a much smaller positive inotropic effect on working guinea pig hearts, but produced a marked and sustained inotropic effect on guinea pig left atria. The toxin also produced arrhythmias in rat and guinea pig hearts, characterized by ventricular tachycardia and A-V blockade. Sympatholytic procedures (beta blockade or reserpine pretreatment) partially blocked the positive inotropic effects, and eliminated the ventricular tachycardia, but not the A-V blockade. Tetrodotoxin markedly inhibited the positive inotropic effect of GbTX-B. Brevetoxin-B did not inhibit guinea pig cardiac Na,K-ATPase activities. The results show that GbTX-B is a potent cardiotoxin and suggest that GbTX-B exerts positive inotropic and arrhythmogenic effects by increasing sarcolemmal sodium permeability, and by releasing catecholamines from sympathetic nerve endings.

Comparative effects of propranolol and nadolol on renal blood flow in normal rats and rats with congestive heart failure

Mean arterial blood pressure (MAP), heart rate (HR), renal blood flow (RBF), and renal vascular resistance (RVR) were determined before and during an infusion of propranolol (18 mg/kg/hr) or nadolol (30 mg/kg/hr) in anesthetized Munich-Wistar rats with normal cardiac function. Eight rats treated with propranolol had significant reductions in MAP (110 to 98 mm Hg; p less than 0.05) and HR (316 to 242 bpm; p less than 0.01), accompanied by a 24% decrease in RBF (5.9 to 4.5 ml/min; p less than 0.05) and a 22% increase in RVR (19.4 to 23.7 mm Hg/ml/min; p less than 0.05). Although nadolol also reduced MAP (104 to 93 mm Hg; p less than 0.01) and HR (315 to 268 bpm; p less than 0.05) in eight other rats, RBF and RVR remained unchanged from baseline levels. Thus, despite similar decrements in MAP and HR, propranolol decreased renal perfusion, whereas nadolol maintained it in animals with noninfarcted myocardium. These parameters were also evaluated in rats with congestive heart failure induced by myocardial infarction at least 3 weeks prior to their receiving either propranolol (18 mg/kg/hr; n = 6) or nadolol (30 mg/kg/hr; n = 6). In the basal state, rats with congestive heart failure had significantly (p less than 0.05) lower MAP, HR, and RBF and higher (p less than 0.01) RVR compared with control rats. Propranolol and nadolol induced comparable falls (p less than 0.05) in MAP and HR. Whereas RBF tended to fall with propranolol (3.3 to 2.4 ml/min), renal perfusion was well maintained with nadolol (3.4 to 3.8 ml/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-four-hour blood pressure profile and blood pressure variability in untreated hypertension and during antihypertensive treatment by once-a-day nadolol

First, blood pressure and heart rate variability was studied in 89 normotensive and hypertensive ambulatory subjects with the use of an intra-arterial monitoring device. Short- and long-term variabilities were analyzed by computer. Absolute variabilities (standard deviations) were greatest in patients with hypertension, but relative variabilities (variation coefficients, i.e., standard deviations as percent of means) were slightly lower in the subjects with more severe hypertension. Second, the effect of nadolol on 24-hour blood pressure and heart rate values and on their variability was assessed in seven ambulatory patients with essential hypertension by means of the same intra-arterial device and computer analysis. Two recording sessions were performed (1) without treatment and (2) after 10 days' administration of nadolol once a day (dose range, 80 to 320 mg). Nadolol, given once a day, was shown to reduce blood pressure uniformly throughout the 24-hour period without loss of activity in the hours farthest from administration. The lack of alteration in relative blood pressure variability suggests that nadolol lowers blood pressure without interfering with the mechanisms involved in cardiovascular homeostasis. Reduction in heart rate variability after nadolol suggests less chance of tachycardia episodes in patients with angina and/or arrhythmias receiving nadolol.

Nadolol compared to propranolol for treating chronic stable angina pectoris

In order to determine the relative efficacy and dose equivalency of propranolol four times a day and nadolol once daily for the treatment of stable angina pectoris, ten patients were studied in a double blind randomized placebo controlled crossover study. Total daily doses of propranolol and nadolol were determined by titrating until an equivalent degree of reduction in the heart rate response to exercise was achieved. At these doses, the treadmill exercise time to 0.1 mV of electrocardiographic ST-segment depression was increased from 248 +/- 75 seconds on placebo to 405 +/- 56 seconds on propranolol (p less than 0.05) and 471 +/- 46 seconds on nadolol (p less than 0.01). Also, the mean frequency of angina decreased from eight attacks per week on placebo to three on propranolol and nadolol (both p less than 0.05). In six of the ten patients, the effective total daily dose of propranolol and nadolol was identical, and the dose ratio for all ten patients was 1.17:1, propranolol to nadolol. However, individual dose titration is recommended when switching from propranolol four times a day to nadolol once daily because of the dosage variability noted in 40 percent of the patients.

Beta-blocking drugs for arrhythmias, hypertension, and ischemic heart disease

Beta-blocking drugs have provided significant improvement in the medical therapy of many types of heart disease. They are more effective in treating young hypertensive patients than elderly hypertensive patients. These drugs reduce the ventricular rate seen in atrial flutter and fibrillation, and they also reduce the frequency of ventricular ectopy. Beta blockers are important adjuncts for control of angina pectoris. When these drugs are given for a period of 1 to 3 years after myocardial infarction they reduce the incidence of reinfarction and the frequency of sudden death as well as reduce the overall mortality rate. Factors that may contribute to the overall decreased mortality include the reduction in the reinfarction rate and an increased threshold for ventricular fibrillation as well as those mechanisms that reduce myocardial oxygen utilization.

Pharmacokinetics of nadolol in healthy subjects

In 7 healthy subjects (3 males and 4 females), the kinetics of nadolol was investigated after oral doses of 60 and 120 mg. The t 1/2 was 14.0 +/- 1.8 h. The peak plasma level was doubled on doubling the dose (from 69 +/- 15 to 132 +/- 27 ng/ml, respectively) and the urinary excretion (13.5%) rose similarly. The half-life of elimination was longer at night than in the day, probably because of the slower nocturnal flow of urine.

Nadolol and supraventricular tachycardia: an electrophysiologic study

To assess antiarrhythmic efficacy of oral nadolol, 15 patients with recurrent supraventricular tachycardia were studied. Eight patients had atrioventricular (AV) nodal reentrant tachycardia and seven had AV reciprocating tachycardia involving an accessory AV pathway. Electrophysiologic studies were performed before and after intravenous infusion of propranolol (0.20 mg/kg), and were repeated 5 to 8 days after oral nadolol therapy at a daily dose of 80 to 160 mg. Both intravenous propranolol and oral nadolol induced significant prolongation of the sinus cycle length from 741 +/- 73 ms to 834 +/- 97 and 1,029 +/- 95 ms, respectively (p less than 0.001 and p less than 0.0001, respectively). Both intravenous propranolol and oral nadolol depressed AV nodal but not accessory AV pathway conduction, and shifted the dual AV nodal pathway conduction curves (A1A2, A2H2; A1A2, H1H2) upward and to the right by prolonging the conduction time and increasing the refractory period. Ten patients (seven with AV nodal reentry and three with AV reciprocation) who responded to intravenous propranolol also responded to oral nadolol with loss of the inducibility of sustained tachycardia; the remaining five patients (one with AV nodal reentry and four with AV reciprocation) who did not respond to intravenous propranolol also failed to respond to oral nadolol with persistence of the inducibility of sustained tachycardia. Thus, in conclusion, intravenous propranolol testing predicts the therapeutic efficacy of oral nadolol therapy and oral nadolol in once-daily doses may be used for long-term prophylaxis of recurrent supraventricular tachycardia.

Diacetyl nadolol: 3-month ocular hypotensive effect in glaucomatous eyes

In a double-masked, 3-month clinical study the ocular hypotensive effects of diacetyl nadolol (DAN), timolol, and nadolol were compared. When applied topically to the eyes of glaucomatous patients timolol 0.5% was found to be significantly more effective than DAN 2% in controlling IOP at 3 of 10 evaluation periods. Fewer patients, however, developed tolerance to DAN 2% than to timolol 0.5%. DAN 0.5% was also effective in lowering intraocular pressure in 3 of 8 patients tested. Nadolol 2% had no long-term ocular hypotensive effect. Two of 8 patients treated with DAN 2% developed a bilateral periorbital dermatitis and were removed from the study even though their intraocular pressures were well controlled. No other clinically significant local or systemic side effects were observed during the course of the study.

Twenty-four-hour hemodynamic profile during treatment of essential hypertension by once-a-day nadolol

The effect of nadolol (N) on 24-hour blood pressure (BP) and heart rate (HR) values and on their variability was examined in ambulant patients with essential hypertension, using the Oxford method to obtain continuous intraarterial recording and a computer to have a beat-to-beat analysis of the data. The recording was carried out without treatment and after 10 days' administration of N once daily by mouth (dose range: 80-320 mg). After N, 24-hour BP and HR were reduced by 17 +/- 3% and 27 +/- 4% respectively as compared to before N, the effect being similar for both systolic and diastolic BP. The hypertension and bradycardia were significantly more marked during the day than during the night, neither showing any attenuation in the hours furthest from the administration of the drug. During N, there was a reduction in the 24-hour variation coefficient for HR but the reduction was limited to the longer term component of this phenomenon, the moment-to-moment variations remaining unaffected. The long- and short-term variation coefficients for BP were not modified under N. These findings suggest that N once a day can reduce BP for 24 hours in ambulant hypertensive patients. The lack of alteration in variability of BP and moment-to-moment HR suggests that the hypotension is achieved without interfering with the mechanisms involved in cardiovascular homeostasis.

Concentration-effect relationships with FM 24: a new long acting beta-adrenergic receptor antagonist

1 FM 24, 1-(2-exo-bicyclo[2,2,1] hept-2-tl phenoxy-3[(1-methyl/ethyl) amino]-2-propanol is a new β-adrenoceptor antagonist. The drug-receptor complex dissociates very slowly in vitro, probably because of the rigidity of the norbornyl ring (Le Fur et al., 1978).

2 Five healthy male volunteers were given single oral doses of placebo, 20, 40, 80, 160 and 320 mg of FM 24. Two hours later a sub-maximal exercise test was carried out with measurement of heart rate and blood pressure and a blood sample was taken for measurement of the plasma concentration of FM 24. Progressive inhibition of exercise tachycardia was observed, related approximately linearly to the log concentration of the drug. At the 320 mg dose a high degree of inhibition of exercise tachycardia occurred with a maximum heart rate of 115 beats min^-1.

3 Five healthy volunteers were then given a single oral dose of 80 mg and 320 mg of FM 24 on separate occasions. Blood samples were taken and submaximal exercise tests were carried out before and at 2, 6, 12, 24, 36, 60, 108 and 168 h after the dose. The plasma concentration fell rapidly during the first 24 h and by that time was less than 10% of the peak value. The degree of inhibition of submaximal exercise tachycardia changed little during the first 24 h after the dose and thereafter declined at a rate which varied in different subjects.

4 The main interest of the study lies in the difference in the concentration-effect relationship 2 h after doses of 20-320 mg and over 7 days after 80 mg or 320 mg doses. At 2 h there was an approximately linear relationship between log FM 24 concentration and inhibition of exercise tachycardia. In the 7 day study the inhibition of exercise tachycardia was on a plateau for the 6-24 h period. During this time the plasma concentration fell rapidly. The data are consistent with a prolonged duration of action due to a slow dissociation of the drug receptor complex, although an active metabolite of FM 24 cannot be excluded. The plateau of effect during the 6-24 h period is of particular interest. One possible explanation is that it represents the turnover time of the cardiac β-adrenoceptors.

Acute electrophysiologic effects of nadolol

The acute effects of intravenous nadolol (0.01 and 0.02 mg/kg) on cardiac electrophysiologic parameters were assessed with His bundle recording and programmed atrial stimulation. The higher dose of nadolol reduced resting heart rate (71 vs. 65 beats/min, P less than 0.02), and the degree of slowing was related to the initial heart rate (r = -0.68, P less than 0.05). Atrioventricular conduction time as defined by the paced A-H interval, rose by 12 msec (P less than 0.001) after nadolol (0.02 mg/kg) administration. Atrial refractoriness increased (by 10 msec, P less than 0.02) only at the higher dose level with nadolol. At both dose levels, atrioventricular nodal effective and functional refractory periods were increased (P less than 0.02) by a mean of 45 and 21 msec, respectively, suggesting greater sensitivity of atrioventricular nodal refractoriness to beta-adrenergic blockade. Nadolol's effects were generally similar to those of previously reported studies with other beta-adrenergic blockers. These data suggest that nadolol slows conduction through the atrioventricular node and increases atrial and atrioventricular nodal refractoriness.

The effects of nadolol on various cardiac tissues in normoxia, and on atrial muscle in simulated ischaemia

Nadolol, a non-selective beta-blocker with a long duration of action, reportedly is devoid of membrane stabilizing action. Since such action is augmented by ischaemic conditions, it was of interest to investigate whether, in simulated ischaemia, a direct membrane effect of nadolol might be revealed. We have confirmed that in normoxia nadolol had no effects on intracellulary recorded potentials in isolated rabbit atrial or ventricular muscle at a concentration of 4.84 microM, but significantly reduced action potential amplitude and maximum rate of depolarisation at 14.5 microM. In Purkinje cells a small reduction of action potential amplitude was produced by 1.61 microM nadolol, but the effect was not increased by nadolol 4.84 microM. There were no drug-induced changes in action potential duration (APD), spontaneous frequency, conduction velocity, contractions, electrical threshold, effective refractory period or the maximum frequency at which a stimulus could be followed. Nadolol 14.5 microM did not reduce the positive inotropic effect of increasing extracellular calcium concentrations. Nadolol was 25 times less potent than procaine as a local anaesthetic on desheathed frog nerve. In a solution simulating ischaemia (8 mM KCl, 10 mM NaHCO3, gassed with 20% O2, pH 7.0) nadolol had a significant class 1 action on atrial muscle, however, even at 4.84 microM and reduced the shortening of APD caused by the solution. It is concluded that nadolol has no class 1, 3 or 4 antiarrhythmic activity in normoxia, but could have an additional protective effect in ischaemic myocardium against the arrhythmogenic factor of shortened APD.

Titration of nadolol in the treatment of hypertension

An open, observer-blind, therapeutic titration trial was carried out in 28 patients with mild or moderate essential hypertension to determine the effective dose range of nadolol given once a day. 11 patients became normotensive (supine diastolic blood pressure 90 mm Hg or below) with 80 mg, 4 with 120 mg and 1 with 160 mg. The largest step in the reduction of blood pressure was achieved with the first dose step of 80 mg, and only a small, nonsignificant further decrease was obtained with higher dose levels. Thus, nadolol, unlike propranolol, has a narrow effective dose range, and this should permit a brief dose adjustment period, which would be important in improving patient compliance.

A study of nadolol to determine its effect on ambulatory blood pressure over 24 hours, and during exercise testing

1 The effect of once daily nadolol therapy in sixteen ambulant patients with essential hypertension has been closely assessed during exercise and over 24 h by continuous intra-arterial recording. 2 The drug was well tolerated and showed similar efficacy to other beta-adrenoceptor blocking agents. Whilst blood pressure reduction was observed throughout the whole day, it was not uniform and lost significance during the morning period when blood pressure levels were highest. 3 This provides further evidence that the antihypertensive action of a beta-adrenoceptor drug over 24 h cannot be predicted from its plasma half-life which, with regard to nadolol, is up to 24 h. 4 An explanation for the loss of blood pressure control during the morning may be that the rapid rise in blood pressure leading to the peak levels at this time may be mediated through alpha- rather than beta-adrenergic receptors at the periphery.

Comparison between atenolol and nadolol in essential hypertension at rest and on exercise

1 The effects of 4 week treatment periods of once-daily atenolol 100 mg, nadolol 80 mg, nadolol 160 mg and placebo on resting and exercise heart rate and blood pressure were compared in a single-blind crossover trial in fifteen patients with essential hypertension. 2 Both atenolol and nadolol, irrespective of dose, reduced resting and exercise blood pressures to the same extent. 3 Nadolol caused a greater bradycardia both at rest and during exercise than did atenolol, thereby effecting a greater reduction in double-product. 4 During progressive treadmill exercise neither atenolol nor nadolol prevented a linear increase in heart rate and blood pressure which were parallel to, but at a lower level than, that produced by placebo. 5 In each individual patient the magnitude of the hypotensive effect produced by one drug was similar to that produced by the other. 6 All the treatment periods resulted in the same linear increase in the patients' perceived exertion scores during exercise despite marked differences in haemodynamic responses evoked by the beta-adrenoceptor blockers compared with placebo. 7 Neither atenolol or nadolol produced any significant change in peak expiratory flow rate compared with placebo.

Comparison of antianginal efficacy of one conventional and three long acting beta-adrenoreceptor blocking agents in stable angina pectoris

We compared the antianginal efficacy of one conventional and three long acting beta-adrenoreceptor blocking agents in a randomised manner in 12 patients with stable angina pectoris. An exercise test was performed initially and in the 24th hour after a single daily dose of 160 mg of each beta-blocker at the end of a two week treatment period. In addition, glyceryl trinitrate consumption, anginal attack rate, and activity scores were recorded. No titration studies to an equivalent degree of beta-blockade were undertaken; a fixed dose was used even though these drugs are not equipotent. Conventional propranolol in a single daily dose of 160 mg was as effective in controlling the frequency of anginal attacks as long acting propranolol and sustained release oxprenolol. Exercise tolerance was less with sustained release oxprenolol than with conventional propranolol, long acting propranolol, and nadolol. Nadolol produced a significantly greater reduction in exercise-induced tachycardia than did long acting propranolol, sustained release oxprenolol, and conventional propranolol, and also the lowest anginal attack rate, the lowest trinitrin consumption, and significantly less ST segment depression than the other three. These findings suggest that nadolol is more potent than long acting propranolol, sustained release oxprenolol, and conventional propranolol, and the antianginal benefit at the 24th hour relates to the degree of beta-adrenoreceptor blockade achieved.

Limitation of myocardial infarct size by atenolol, nadolol and propranolol in dogs

The importance of cardioselectivity and membrane depressant activity in the ability of beta-adrenergic antagonists to limit myocardial infarct size was assessed in the dog. Infarction was produced by a 60 min occlusion of the left circumflex coronary artery followed by reperfusion into a critical stenosis. Infarct size was significantly reduced by atenolol, nadolol and propranolol. Thus, limitations of infarct size by beta-adrenergic antagonists occur with agents which possess or lack cardiac selectivity or membrane depressant activity.

Comparison of nadolol, a new long-acting beta-receptor blocking agent, and placebo in the treatment of stable angina pectoris

Nadolol, a new nonselective beta 1 and beta 2 adrenergic blocking agent, has a plasma half-life of 17 to 23 hours. We studied 37 volunteers with stable angina pectoris who had five or more episodes of pain per week and who also had a 1 mm or greater ST segment depression 80 msec past the J point during a Bruce protocol treadmill test. An eight-week placebo controlled run-in period preceded double-blind randomization to nadolol administered once per day (17 patients) or identical appearing placebo for four weeks (20 patients), after which an exercise test was done. Diaries for pain episodes and nitroglycerin consumption were kept. Exercise tests were performed 24 hours after the last nadolol or placebo dose. Episodes of pain per week were reduced 59.8 percent after nadolol and 28.2 percent after placebo (P less than .01). Nitroglycerin consumption after nadolol was reduced 66.8 percent while after placebo it was reduced 36.2 percent (P less than .05). Resting and peak heart rates and peak rate-pressure products showed typical reductions due to beta-blockade 24 hours after nadolol compared with stability of these during placebo, all P less than .001. Exercise time after nadolol increased 42.2 percent, which was more than the 14.5 percent increase after placebo (P less than .05). Exercise work after nadolol increased 64.7 percent, greater than the 22 percent increase after placebo (P less than .05). Mean ST segment depression at end of exercise was little changed before and after treatment in both groups, reflecting consistency of effort. Improvement in symptoms and work capacity associated with nadolol significantly exceeded the placebo group responses. Unlike other available agents of this class, a single daily dose of nadolol produced therapeutically effective 24-hour beta-blockade in patients with disabling angina pectoris.