Ratio-Nadolol

Angina Pectoris

Ratio-Nadolol (Ratio-Nadolol) is indicated for the long-term management of patients with angina pectoris.

Hypertension

Ratio-Nadolol (Ratio-Nadolol) is indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including the class to which this drug principally belongs. There are no controlled trials demonstrating risk reduction with Ratio-Nadolol.

Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than one drug to achieve blood pressure goals. For specific advice on goals and management, see published guidelines, such as those of the National High Blood Pressure Education Program's Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC).

Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits. The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly.

Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit. Relative risk reduction from blood pressure reduction is similar across populations with varying absolute risk, so the absolute benefit is greater in patients who are at higher risk independent of their hypertension (for example, patients with diabetes or hyperlipidemia), and such patients would be expected to benefit from more aggressive treatment to a lower blood pressure goal.

Some antihypertensive drugs have smaller blood pressure effects (as monotherapy) in black patients, and many antihypertensive drugs have additional approved indications and effects (e.g., on angina, heart failure, or diabetic kidney disease). These considerations may guide selection of therapy.

Ratio-Nadolol (Ratio-Nadolol) may be used alone or in combination with other antihypertensive agents, especially thiazide-type diuretics.

Ratio-Nadolol is used alone or together with other medicines (such as hydrochlorothiazide) to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Ratio-Nadolol is also used to treat severe chest pain (angina).

Ratio-Nadolol is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

Ratio-Nadolol is available only with your doctor's prescription.

DOSAGE MUST BE INDIVIDUALIZED. Ratio-Nadolol (Ratio-Nadolol) MAY BE ADMINISTERED WITHOUT REGARD TO MEALS.

Angina Pectoris

The usual initial dose is 40 mg Ratio-Nadolol (Ratio-Nadolol) once daily. Dosage may be gradually increased in 40 to 80 mg increments at 3 to 7 day intervals until optimum clinical response is obtained or there is pronounced slowing of the heart rate. The usual maintenance dose is 40 or 80 mg administered once daily. Doses up to 160 or 240 mg administered once daily may be needed.

The usefulness and safety in angina pectoris of dosage exceeding 240 mg per day have not been established. If treatment is to be discontinued, reduce the dosage gradually over a period of one to two weeks.

Hypertension

The usual initial dose is 40 mg Ratio-Nadolol (Ratio-Nadolol) once daily, whether it is used alone or in addition to diuretic therapy. Dosage may be gradually increased in 40 to 80 mg increments until optimum blood pressure reduction is achieved. The usual maintenance dose is 40 or 80 mg administered once daily. Doses up to 240 or 320 mg administered once daily may be needed.

Dosage Adjustment in Renal Failure

Absorbed Ratio-Nadolol is excreted principally by the kidneys and, although nonrenal elimination does occur, dosage adjustments are necessary in patients with renal impairment. The following dose intervals are recommended:

How supplied

Ratio-Nadolol Tablets (Ratio-Nadolol Tablets USP)

20 mg tablets in bottles of 100 (NDC 60793–800–01),

40 mg tablets in bottles of 100 (NDC 60793–801–01) and

80 mg tablets in bottles of 100 (NDC 60793–802–01).

All tablets are scored (bisect bar) and easy to break. Tablet identification numbers: 20 mg, 232; 40 mg, 207; and 80 mg, 241.

Storage

Store at room temperature; avoid excessive heat. Protect from light. Keep bottle tightly closed.

Revised July 2013. Distributed by: Pfizer Inc, New York, NY 10017

See also:
What is the most important information I should know about Ratio-Nadolol?

Do not stop taking Ratio-Nadolol without first talking to your doctor. Stopping suddenly may make your condition worse.

If you need surgery, tell the surgeon ahead of time that you are using Ratio-Nadolol. You may need to stop using the medicine for a short time.

Ratio-Nadolol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Ratio-Nadolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

Use Ratio-Nadolol as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Ratio-Nadolol by mouth with or without food.
• Take Ratio-Nadolol on a regular schedule to get the most benefit from it. Taking Ratio-Nadolol at the same time each day will help you remember to take it.
• Continue to take Ratio-Nadolol even if you feel well. Do not miss any doses.
• Do not suddenly stop taking Ratio-Nadolol. You may have an increased risk of side effects. If you need to stop Ratio-Nadolol, your doctor will gradually lower your dose.
• If you miss a dose of Ratio-Nadolol, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Ratio-Nadolol.

Use: Labeled Indications

Angina: Treatment of angina pectoris

Hypertension: Management of hypertension. Note: Beta-blockers are not recommended as first-line therapy (ACC/AHA [Whelton 2017]).

Off Label Uses

Atrial fibrillation (rate control)

Based on the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for the management of patients with atrial fibrillation (AF), the use of beta-blockers, including Ratio-Nadolol, for ventricular rate control in patients with paroxysmal, persistent, or permanent AF is effective and recommended for this condition.

Catecholaminergic polymorphic ventricular tachycardia (prevention)

In patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), data from an observational study suggests that beta-blockers, especially Ratio-Nadolol, may be beneficial at reducing the risk of cardiac events. Additional data may be necessary to further define the role of Ratio-Nadolol in this condition. Atenolol, Ratio-Nadolol, and propranolol may be preferred for patients with LQTS based on the currently available data.

Based on the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for management of patients with ventricular arrhythmias and prevention of sudden cardiac death, beta-blockers are effective for control of ventricular arrhythmias in patients with congenital LQTS.

Ventricular premature beat (suppression)

Based on the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for management of patients with ventricular arrhythmias and prevention of sudden cardiac death, beta-blockers are effective for control of ventricular premature beats.

Ventricular tachycardia (prevention)

Based on the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for management of patients with ventricular arrhythmias and prevention of sudden cardiac death, beta-blockers are effective for prevention of ventricular tachycardia.

See also:
What other drugs will affect Ratio-Nadolol?

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include: alpha blockers (e.g., prazosin), arbutamine, other beta blockers (e.g., atenolol), calcium channel blockers (e.g., diltiazem, verapamil), clonidine, epinephrine, fenoldopam, fingolimod, methyldopa, nasal decongestants (e.g., phenylephrine, pseudoephedrine), neuromuscular blocking agents (e.g., tubocurarine), reserpine, "water pills" (e.g., diuretics such as furosemide).

Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, risperidone, amitriptyline, trazodone).

Check the labels on all your medicines (such as cough-and-cold products, diet aids, or NSAIDs such as ibuprofen, naproxen) because they may contain ingredients that could cause drowsiness or increase your heart rate or blood pressure. Ask your pharmacist for more details.

See also:
What are the possible side effects of Ratio-Nadolol?

Applies to Ratio-Nadolol: oral tablet

In addition to its needed effects, some unwanted effects may be caused by Ratio-Nadolol (the active ingredient contained in Ratio-Nadolol). In the event that any of these side effects do occur, they may require medical attention.

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking Ratio-Nadolol:

Less common:

• Blurred vision
• chest pain or discomfort
• confusion
• dilated neck veins
• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
• extreme fatigue
• irregular breathing
• lightheadedness, dizziness, or fainting
• paleness or cold feeling in fingertips and toes
• shortness of breath
• slow or irregular heartbeat
• sweating
• swelling of face, fingers, feet, or lower legs
• tingling or pain in fingers or toes when exposed to cold
• unusual tiredness or weakness
• weight gain
• wheezing

• Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• changes in behavior
• cough
• difficulty breathing
• noisy breathing
• slurred speech
• tightness in chest

Minor Side Effects

Some of the side effects that can occur with Ratio-Nadolol may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Rare

• Bloated
• continuing ringing or buzzing or other unexplained noise in ears
• decreased interest in sexual intercourse
• diarrhea
• difficulty having a bowel movement (stool)
• drowsiness
• dry mouth, eyes, or skin
• excess air or gas in stomach or intestines
• full feeling
• gas in stomach
• hair loss, thinning of hair
• headache
• hearing loss
• heartburn
• inability to have or keep an erection
• itching skin
• loss in sexual ability, desire, drive, or performance
• loss of appetite
• nausea
• passing gas
• rash
• relaxed and calm
• sleepiness
• stomach pain
• stomach soreness or discomfort
• stuffy nose
• vomiting
• weight loss

A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Ratio-Nadolol is also used for migraine disorders and for tremor. [PubChem]