Nadolol and Lidocaine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lidocaine
Nadolol
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Lidocaine toxicity (anxiety, myocardial depression, cardiac arrest)
Interaction Deep Dive
Propranolol, nadolol, and metoprolol may increase lidocaine levels by 20% to 30%612.
Why it happens (mechanism)
Decreased lidocaine metabolism
Literature reports
2 reports — tap to read
a) Concomitant lidocaine and beta-blocker therapy may reduce the clearance of lidocaine from plasma. This effect may be attributed to beta-blocker-induced reduction in cardiac output and hepatic blood flow, and inhibition of hepatic microsomal enzymes. A 30% increase in mean steady-state concentrations of lidocaine has been observed during concomitant propranolol therapy. Propranolol, metoprolol, and nadolol have been reported to reduce lidocaine clearance by 15% to 45%. This difference is of clinical significance and the lidocaine dosage should be adjusted. This effect will be additive to the accumulation seen during continuous lidocaine infusions. Additionally, the negative inotropic effect of propranolol, and possibly other beta-blockers, may be enhanced by lidocaine 1234.
b) Both nadolol and propranolol are reported to decrease lidocaine plasma clearance in healthy volunteers 1. Six patients received three separate 30-hour infusions of lidocaine 2 mg/min, one given alone, one given following 3 days of pretreatment with nadolol 160 mg PO daily, and one following 3 days of pretreatment with propranolol 80 mg PO Q8H. In addition to reductions in lidocaine plasma clearance, lidocaine plasma levels were increased by both drugs and hepatic blood flow (determined by indocyanine green) decreased with nadolol (1275 to 902 mL/minute) and propranolol (1275 to 957 mL/minute). The hepatic extraction ratio for lidocaine was increased to a similar degree by each drug; lidocaine intrinsic clearance was not changed by either drug. These data suggest that both beta-blockers can reduce lidocaine clearance by a reduction in hepatic blood flow, but not by inhibition of lidocaine metabolism. Two cases of lidocaine toxicity were reported during concomitant administration of normal doses of propranolol and lidocaine. The first case was a 56-year-old woman receiving 40 mg of oral propranolol daily who was given a 50 mg bolus of lidocaine to control ventricular premature contractions. The patient was then placed on a lidocaine drip, and within 15 minutes reported lightheadedness and accentuated bradycardia, which led to sinus arrest. The second case involved a 40-year-old woman on 160 mg of oral propranolol daily who received a 100 mg bolus of lidocaine to control ventricular tachycardia. A continuous lidocaine infusion at a rate of 2 mg/minute was initiated, and after 3.5 hours, the patient became hysterical and combative. The infusion was discontinued and the patient returned to a normal mental state within 15 minutes. The lidocaine infusion was resumed at 1 mg/minutes with no difficulties 5.
Common questions
Can I take Nadolol and Lidocaine together?
Lidocaine toxicity (anxiety, myocardial depression, cardiac arrest) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Nadolol and Lidocaine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Nadolol or Lidocaine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (6)
- Schneck DW, Luderer JR, Davis D, et al: Effects of nadolol and propranolol on plasma lidocaine clearance. Clin Pharmacol Ther 1984; 36:584-587. PubMed
- Conrad KA, Byers MJ III, Finley PR, et al: Lidocaine elimination: effects of metoprolol and of propranolol. Clin Pharmacol Ther 1983; 33:133-138. DOI
- Bax ND, Tucker GT, Lennard MS, et al: The impairment of lidocaine clearance by propranolol-major contribution from enzyme inhibition. Br J Clin Pharmacol 1985; 19:597-603.
- Ochs HR, Carstens G, & Greenblatt DJ: Reduction in lidocaine clearance during continuous infusion and by coadministration of propranolol. N Engl J Med 1980; 303:373-378. PubMed
- Graham CF, Turner WM, & Jones JK: Lidocaine-propranolol interactions (letter). N Engl J Med 1981; 304:1301. DOI
- Miners JO, Wing LM, Lillywhite KJ, et al: Failure of 'therapeutic' doses of beta-adrenoceptor antagonists to alter the disposition of tolbutamide and lignocaine. Br J Clin Pharmacol 1984; 18:853-860. PubMed
Keep reading about Lidocaine
Keep reading about Nadolol
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