Can't Fill Your Nadolol Prescription? Here Are Your Options

If your pharmacy has told you that Nadolol is unavailable or on backorder, you may be wondering what other medications could work for you. You're not alone — Nadolol has faced intermittent shortages in recent years, leaving patients scrambling for alternatives.

The good news is that there are several beta-blockers in the same drug class that may work similarly for your condition. In this post, we'll explain how Nadolol works, then walk you through four common alternatives you can discuss with your doctor.

Important: Never switch medications on your own. Always talk to your prescriber before making any changes to your treatment.

What Is Nadolol and How Does It Work?

Nadolol (brand name Corgard) is a non-selective beta-blocker. It's FDA-approved to treat high blood pressure and angina (chest pain). Doctors also prescribe it off-label for conditions like migraine prevention, portal hypertension, essential tremor, and heart rhythm problems.

Beta-blockers work by blocking the effects of adrenaline on your heart and blood vessels. This slows your heart rate, lowers blood pressure, and reduces the workload on your heart.

What makes Nadolol different from many other beta-blockers:

• Long half-life (20-24 hours): You only need to take it once a day
• Not lipophilic: It doesn't easily cross into the brain, so it causes fewer central nervous system side effects like depression, nightmares, or fatigue compared to some other beta-blockers
• Non-selective: It blocks both beta-1 receptors (in the heart) and beta-2 receptors (in the lungs and blood vessels)

4 Alternatives to Nadolol

1. Propranolol (Inderal)

Propranolol is the closest alternative to Nadolol because it's also a non-selective beta-blocker. It's used for high blood pressure, angina, tremor, migraine prevention, and anxiety.

Key differences from Nadolol:

• Shorter half-life — usually taken 2-3 times daily (though an extended-release version, Inderal LA, allows once-daily dosing)
• Crosses the blood-brain barrier more easily, which means more potential for CNS side effects (fatigue, vivid dreams, depression)
• Widely available and inexpensive as a generic — typically $4-$15 for a 30-day supply with a discount card

Best for: Patients who need a non-selective beta-blocker and can tolerate more frequent dosing or use the extended-release form.

2. Atenolol (Tenormin)

Atenolol is a selective beta-1 blocker, meaning it primarily targets the heart without blocking beta-2 receptors in the lungs. It's FDA-approved for high blood pressure, angina, and to reduce the risk of cardiovascular complications after a heart attack.

Key differences from Nadolol:

• Selective for beta-1 receptors — generally safer for patients with mild asthma or COPD (though still used with caution)
• Once-daily dosing similar to Nadolol
• Very affordable — generic Atenolol typically costs $4-$10 for a 30-day supply

Best for: Patients with high blood pressure or angina who need a once-daily pill and may have mild respiratory concerns.

3. Metoprolol (Lopressor, Toprol XL)

Metoprolol is another selective beta-1 blocker and one of the most commonly prescribed beta-blockers in the United States. It comes in two forms: immediate-release (Lopressor, taken twice daily) and extended-release (Toprol XL, taken once daily).

Key differences from Nadolol:

• Available in extended-release form for once-daily dosing
• Beta-1 selective — less impact on the lungs
• More lipophilic than Nadolol, so it may cause more CNS side effects
• Extremely widely available — one of the easiest beta-blockers to find in stock
• Generic cost is typically $4-$20 for a 30-day supply

Best for: Patients who need a reliable, widely available beta-blocker with once-daily dosing (Toprol XL).

4. Bisoprolol (Zebeta)

Bisoprolol is a highly selective beta-1 blocker that's taken once daily. It's FDA-approved for high blood pressure and is commonly used off-label for heart failure.

Key differences from Nadolol:

• Highly beta-1 selective — even safer choice for patients with respiratory conditions
• Once-daily dosing
• Less commonly prescribed than Metoprolol or Atenolol, but generally available
• Generic cost typically $10-$30 for a 30-day supply

Best for: Patients who need a selective beta-blocker with once-daily dosing, especially those with respiratory concerns.

How to Talk to Your Doctor About Switching

If you can't find Nadolol and need to consider an alternative, here are some things to bring up with your doctor:

• Why you were prescribed Nadolol specifically: If it was for its non-selective properties (e.g., portal hypertension, migraine prevention), Propranolol may be the best swap. If it was primarily for blood pressure, a selective beta-blocker like Atenolol or Metoprolol may work well.
• Your other health conditions: If you have asthma or COPD, a selective beta-1 blocker is generally preferred over a non-selective one.
• Side effect concerns: If you chose Nadolol because it has fewer CNS side effects, be aware that Propranolol and Metoprolol may cause more fatigue or sleep disturbances.
• Dosing preferences: If you value once-daily dosing, make sure the alternative offered supports that schedule.

Still Looking for Nadolol?

Before switching, it's worth checking whether Nadolol is available at another pharmacy near you. Use Medfinder to search real-time availability at pharmacies in your area. Read our full guide on how to find Nadolol in stock for more tips.

Final Thoughts

While Nadolol is a great medication with unique benefits, there are several effective alternatives available if you can't fill your prescription. Propranolol, Atenolol, Metoprolol, and Bisoprolol are all well-established beta-blockers that your doctor can consider based on your specific needs.

The most important thing is to never stop taking your beta-blocker abruptly — always work with your doctor to transition safely. And if cost is a factor in your decision, check out our guide on how to save money on Nadolol and its alternatives.