Nadolol Shortage: A Provider Briefing for 2026

Nadolol, the long-acting non-selective beta-adrenergic blocker marketed under the brand name Corgard, has experienced recurring supply disruptions that directly impact patient care. For providers managing patients on Nadolol for hypertension, angina, portal hypertension, migraine prophylaxis, or other indications, understanding the current landscape is essential for clinical decision-making and patient communication.

This briefing covers the shortage timeline, prescribing implications, current availability, cost considerations, and clinical tools available to support your patients and practice.

Shortage Timeline

Nadolol supply issues have been reported intermittently since 2019. Key milestones include:

• 2019-2020: Initial reports of limited supply for certain tablet strengths, particularly 80 mg, as generic manufacturer consolidation reduced the number of active producers
• 2021-2023: Periodic disruptions tied to global supply chain challenges, including raw material sourcing delays and shipping bottlenecks affecting active pharmaceutical ingredient (API) availability
• 2024-2025: Continued intermittent shortages with some pharmacies reporting weeks-long backorders for specific strengths
• 2026 (current): Supply remains inconsistent. The 80 mg and 160 mg strengths are most commonly reported as unavailable, while 20 mg and 40 mg tablets are generally more accessible but still subject to regional variation

The ASHP Drug Shortage Resource Center and FDA Drug Shortage Database should be consulted for the most current status updates.

Prescribing Implications

The intermittent nature of Nadolol shortages presents several clinical challenges:

Patient Adherence and Safety

Patients who cannot fill their prescriptions face the risk of abrupt beta-blocker discontinuation, which can precipitate rebound tachycardia, angina exacerbation, and in rare cases, myocardial infarction. Providers should proactively counsel patients on the importance of not abruptly stopping Nadolol and provide clear guidance on what to do if they cannot obtain their medication.

Dose Substitution Considerations

If the prescribed strength is unavailable, it may be possible to achieve the same daily dose using available strengths. For example:

• A patient on 80 mg daily could take two 40 mg tablets
• A patient on 160 mg daily could take two 80 mg tablets (if available) or four 40 mg tablets

This approach requires a new prescription specifying the alternative strength and quantity. Coordinating with the dispensing pharmacy to confirm availability before writing the prescription will save patients time and frustration.

Therapeutic Substitution

When Nadolol is unavailable and dose substitution is not feasible, therapeutic substitution with another beta-blocker may be necessary. Key considerations:

• For non-selective beta-blockade (e.g., portal hypertension, migraine prophylaxis, essential tremor): Propranolol is the most appropriate substitute. Consider the extended-release formulation (Inderal LA) for once-daily dosing. Propranolol LA 60-160 mg daily is a reasonable starting range depending on the indication.
• For hypertension and angina (where non-selectivity is not critical): Atenolol (25-100 mg daily) or Metoprolol succinate extended-release (25-200 mg daily) are well-established alternatives with strong evidence bases and reliable supply.
• For patients with respiratory comorbidities: Selective beta-1 blockers (Atenolol, Metoprolol, Bisoprolol) are preferred to minimize the risk of bronchospasm.

Approximate dose equivalency guidance:

• 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

Note: Dose conversion is approximate and should be individualized based on patient response, comorbidities, and tolerability.

Current Availability Picture

As of early 2026, Nadolol availability varies significantly by:

• Strength: 20 mg and 40 mg tablets are generally easier to source than 80 mg and 160 mg
• Region: Supply gaps are not uniform nationally; some areas are well-stocked while others face persistent shortages
• Pharmacy type: Independent pharmacies with access to multiple wholesalers may have better success sourcing Nadolol than chain pharmacies relying on a single distributor

Current generic manufacturers include Amneal Pharmaceuticals and Greenstone LLC. The brand product Corgard has been largely discontinued.

Cost and Access Considerations

Cost can be an additional barrier to access, particularly for uninsured or underinsured patients:

• Cash price: $90-$300 per month depending on strength and pharmacy
• With discount programs: $26-$50 for 90 tablets (20 mg) through SingleCare, GoodRx, or similar programs
• Insurance: Generic Nadolol is typically Tier 1 or Tier 2 on most commercial and Medicare Part D formularies. Prior authorization is generally not required.

For patients facing cost barriers, coupon and discount programs can significantly reduce out-of-pocket costs. Patient assistance programs through NeedyMeds and RxAssist may help qualifying low-income patients.

Tools and Resources for Providers

Several tools can help streamline the process of locating Nadolol for your patients:

• Medfinder for Providers: Real-time pharmacy stock search that helps identify which pharmacies in your patient's area currently have Nadolol available. This eliminates the burden on patients of calling multiple pharmacies.
• ASHP Drug Shortage Resource Center: Official shortage status updates and expected resolution timelines
• FDA Drug Shortage Database: Regulatory updates on manufacturing status and supply projections

Workflow Recommendations

1. Verify availability before prescribing: When prescribing Nadolol or renewing a prescription, consider using Medfinder to confirm stock at the patient's preferred pharmacy
2. Prescribe flexible quantities: Consider writing for the specific strength and quantity that matches current availability (e.g., 40 mg tablets with instructions to take two if 80 mg is unavailable)
3. Document the shortage: Note supply issues in the patient's chart to support future prior authorization requests or formulary exception appeals
4. Proactive patient communication: Inform patients taking Nadolol about the ongoing supply situation and provide a backup plan (alternative medication, dose substitution strategy) before they run out

Looking Ahead

There is no indication that Nadolol supply will fully normalize in the near term. The fundamental market dynamics — few manufacturers, low margins, overseas API sourcing — remain unchanged. Providers should continue to maintain contingency plans for affected patients and monitor shortage databases for updates.

The FDA has encouraged manufacturers to increase production, but the timeline for meaningful supply improvement remains uncertain.

Final Thoughts

The Nadolol shortage requires proactive management from prescribers. By understanding the clinical alternatives, leveraging real-time tools like Medfinder, and maintaining open communication with patients, providers can minimize treatment disruptions and ensure continuity of care.

For a patient-facing perspective on the shortage, see our Nadolol shortage update for patients. For a practical guide on helping patients locate their medication, read how to help your patients find Nadolol in stock.