Your Patients Can't Find Nadolol — Here's How You Can Help

As a prescriber, few things are more frustrating than knowing the right medication for your patient — only to learn it's unavailable at their pharmacy. Nadolol, the long-acting non-selective beta-blocker, has been subject to intermittent shortages since 2019, and many patients continue to struggle to fill their prescriptions in 2026.

This guide provides a practical, step-by-step approach to help your patients access Nadolol — or an appropriate alternative — with minimal disruption to their care.

Current Nadolol Availability

Nadolol is manufactured generically by Amneal Pharmaceuticals and Greenstone LLC, among others. The brand product Corgard has been largely phased out. Current availability varies by:

• Tablet strength: The 20 mg and 40 mg tablets tend to be more consistently available than the 80 mg and 160 mg strengths
• Geography: Supply gaps are regional, with some markets adequately stocked and others experiencing prolonged backorders
• Pharmacy type: Independent pharmacies with multiple wholesaler relationships often have better access to limited-supply medications

Why Patients Can't Find Nadolol

Understanding the root causes helps frame conversations with patients and informs prescribing decisions:

1. Manufacturer consolidation: Fewer companies produce Nadolol, concentrating supply risk
2. API sourcing challenges: Active pharmaceutical ingredients are primarily sourced internationally, subject to supply chain delays
3. Low economic incentive: As a low-cost generic, Nadolol offers minimal profit margin, discouraging new market entrants
4. Unpredictable demand: Broad off-label use (portal hypertension, migraine, tremor, long QT syndrome) means demand can exceed projections

5 Steps to Help Your Patients Access Nadolol

Step 1: Verify Availability Before Sending the Prescription

The simplest intervention is confirming that the patient's pharmacy has Nadolol in stock before they make the trip. Tools like Medfinder for Providers allow you to search real-time inventory at pharmacies in your patient's area. This takes seconds and can save your patient significant time and frustration.

If their usual pharmacy is out of stock, you can send the prescription directly to an alternative pharmacy that has it available.

Step 2: Consider Dose-Equivalent Strength Substitution

If the prescribed strength is unavailable but other strengths are in stock, consider adjusting the prescription. For example:

• Patient prescribed Nadolol 80 mg once daily → Prescribe Nadolol 40 mg, take two tablets once daily
• Patient prescribed Nadolol 160 mg once daily → Prescribe Nadolol 40 mg, take four tablets once daily

This requires a new prescription but can be an effective workaround. Confirm the alternative strength is available at the pharmacy before writing it.

Step 3: Explore Therapeutic Alternatives

When Nadolol is genuinely unavailable in any strength, therapeutic substitution may be necessary. Match the alternative to the clinical indication:

• Portal hypertension / variceal prophylaxis: Propranolol (non-selective) or Carvedilol
• Hypertension: Atenolol, Metoprolol succinate ER, or Bisoprolol
• Angina: Atenolol or Metoprolol succinate ER
• Migraine prophylaxis: Propranolol LA
• Essential tremor: Propranolol

Approximate dose equivalencies:

• Nadolol 40 mg ≈ Propranolol LA 80 mg ≈ Atenolol 50 mg ≈ Metoprolol succinate ER 50 mg
• Nadolol 80 mg ≈ Propranolol LA 160 mg ≈ Atenolol 100 mg ≈ Metoprolol succinate ER 100 mg

Monitor patients closely during the transition period, particularly for heart rate and blood pressure response. For detailed information on alternatives, see our patient-facing alternatives guide.

Step 4: Direct Patients to Cost-Saving Resources

The shortage can compound cost concerns, especially if patients need to switch pharmacies or fill at a non-preferred location. Point patients toward:

• Discount card programs: SingleCare, GoodRx, and RxSaver can reduce generic Nadolol to $26-$50 for a 90-day supply
• Patient assistance programs: NeedyMeds and RxAssist maintain databases of programs for low-income patients
• Mail-order pharmacies: May have different supply access and often offer lower per-unit pricing

Our savings guide for Nadolol provides detailed information patients can reference.

Step 5: Create a Proactive Contingency Plan

For patients on chronic Nadolol therapy, build a shortage contingency plan into their care:

• Document an alternative medication and dose in the chart
• Discuss the contingency plan with the patient so they know what to do if Nadolol is unavailable
• Set up bridge prescriptions — have a backup prescription for an alternative ready to activate
• Encourage early refills (7+ days before running out) during shortage periods

Workflow Tips for Your Practice

Integrating shortage management into your clinical workflow can reduce reactive problem-solving:

• Bookmark Medfinder for Providers for quick availability checks during patient encounters
• Create a shortage protocol: Standardize your approach for Nadolol and other commonly shorted medications with pre-approved substitution orders
• Delegate verification: Train clinical staff (MAs, nurses, pharmacy liaisons) to check stock availability before appointments for patients on shortage-prone medications
• Batch communications: If Nadolol supply worsens, proactively reach out to all affected patients via portal message rather than handling issues one-by-one as prescriptions fail to fill
• Document everything: Note shortage-related changes in the chart to support formulary exception requests, prior authorizations, and continuity of care across providers

Alternatives at a Glance

Quick reference for the most common Nadolol alternatives:

• Propranolol (Inderal LA): Non-selective, best substitute for portal hypertension and migraine. Generic cost: $4-$15/month.
• Atenolol (Tenormin): Beta-1 selective, once-daily, excellent for hypertension and angina. Generic cost: $4-$10/month.
• Metoprolol succinate ER (Toprol XL): Beta-1 selective, once-daily, most widely available beta-blocker. Generic cost: $4-$20/month.
• Bisoprolol (Zebeta): Highly beta-1 selective, once-daily, preferred with respiratory comorbidities. Generic cost: $10-$30/month.

Final Thoughts

The Nadolol shortage is a clinical reality that requires proactive management. By verifying availability before prescribing, maintaining flexible substitution plans, and leveraging tools like Medfinder for Providers, you can minimize treatment disruptions for your patients.

For the clinical background on the shortage, see our provider shortage briefing. For provider-focused savings strategies, read our guide on helping patients save money on Nadolol.