VT. X nadolol

Nadolol is a non-selective beta-blocker (blocks both β1 and β2 receptors) that can be used off-label in pediatric patients, including for certain ventricular tachycardia (VT) types in children.

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Use of Nadolol in Children with VT

• Indication (off-label): Treatment or prevention of ventricular tachycardia, especially in:
  
• Catecholaminergic Polymorphic VT (CPVT)
• Long QT Syndrome (LQTS)
• Some other forms of idiopathic or arrhythmia-related VT
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• Often chosen when a long-acting beta-blocker is preferred or when compliance with multiple daily doses is a challenge.

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Dosing in Pediatrics (General Guidance – always individualised)

Must be prescribed and titrated under specialist supervision (cardiologist or pediatric electrophysiologist).

• Starting dose: ~0.5 to 1 mg/kg/day once daily
• Max dose: Up to 2 mg/kg/day, not exceeding adult doses (typically capped at 160 mg/day)
• Form: Oral tablets (can be crushed or compounded into a liquid suspension for younger children)

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Advantages of Nadolol

• Once-daily dosing due to long half-life (~20-24 hours)
• Well tolerated
• Fewer central nervous system side effects (less lipophilic than propranolol)

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Precautions / Side Effects

• Bradycardia
• Hypotension
• Fatigue, cold extremities
• Hypoglycemia masking (especially in infants)
• Bronchospasm (due to β2 blockade – caution in asthma)

🧠 Clinical Pearl:

In CPVT or LQTS, nadolol is sometimes preferred over propranolol due to:

• Better adherence (once daily)
• More stable plasma levels
• Lower recurrence of arrhythmias in some studies

Would you like:

• A dosing chart by weight?
• Comparison with other beta-blockers like propranolol or atenolol?
• Guidance on compounding or administration for infants?