Nebivolol: Uses, Dosage, and Side Effects Overview

Summary of Key Points

Nebivolol is a beta-blocker commonly prescribed to manage high blood pressure (hypertension) and other heart-related conditions. It works by relaxing blood vessels and slowing the heart rate, which helps improve blood flow and lower blood pressure. While Nebivolol is generally well-tolerated, like all medications, it may cause side effects. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to help manage your treatment.

Names of Medication

US Brand Name: Bystolic

Generic Name: Nebivolol

The generic name refers to the active ingredient in the medication, which is listed in parentheses next to the brand name.

Pharmacologic Category

Nebivolol belongs to a class of medications known as beta-blockers. Other medications in this category include:

1. Atenolol
2. Metoprolol
3. Propranolol
4. Bisoprolol

Nebivolol Dosage

Nebivolol is prescribed for various heart-related conditions, and the dosage may vary depending on the specific condition being treated. Always follow your doctor’s instructions and consult them before making any changes to your dosage. If you need assistance, our telemedicine providers are available to guide you.

Hypertension (High Blood Pressure)

Initial Dose: 5 mg once daily.

Maintenance Dose: Can be increased up to 40 mg once daily, depending on your response to the medication.

Heart Failure

Initial Dose: 1.25 mg once daily.

Maintenance Dose: Can be gradually increased every 1-2 weeks up to 10 mg once daily, depending on tolerance and response.

Angina (Chest Pain)

Initial Dose: 5 mg once daily.

Maintenance Dose: Can be increased up to 40 mg once daily, depending on your response.

Atrial Fibrillation

Initial Dose: 5 mg once daily.

Maintenance Dose: Can be increased up to 40 mg once daily, depending on your response.

Tachycardia (Fast Heart Rate)

Initial Dose: 5 mg once daily.

Maintenance Dose: Can be increased up to 40 mg once daily, depending on your response.

Myocardial Infarction (Heart Attack)

Initial Dose: 5 mg once daily.

Maintenance Dose: Can be increased up to 40 mg once daily, depending on your response.

Coronary Artery Disease

Initial Dose: 5 mg once daily.

Maintenance Dose: Can be increased up to 40 mg once daily, depending on your response.

Arrhythmia

Initial Dose: 5 mg once daily.

Maintenance Dose: Can be increased up to 40 mg once daily, depending on your response.

Peripheral Vascular Disease

Initial Dose: 5 mg once daily.

Maintenance Dose: Can be increased up to 40 mg once daily, depending on your response.

Dosage Forms and Strengths

Nebivolol is available in the following forms and strengths:

1. Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg

Administration Instructions

Nebivolol should be taken orally, with or without food, once daily. It’s important to take the medication at the same time each day to maintain consistent levels in your bloodstream. Do not crush or chew the tablets. If you miss a dose, take it as soon as you remember, but skip it if it’s almost time for your next dose. Never double up on doses. Always consult your healthcare provider if you have any questions about how to take this medication. Our telemedicine providers are available to assist you.

Nebivolol Side Effects and Adverse Reactions

Like all medications, Nebivolol may cause side effects. Most are mild, but some can be more serious. If you experience severe or persistent symptoms, contact your healthcare provider immediately.

Common Side Effects (1-10%): Headache, fatigue, dizziness, nausea, slow heart rate (bradycardia).

Less Common Side Effects (0.1-1%): Shortness of breath, swelling in the legs or ankles, difficulty sleeping, depression.

Rare Side Effects (<0.1%): Severe allergic reactions, chest pain, fainting, worsening heart failure.

Contraindications for Nebivolol

A contraindication is a specific situation where a medication should not be used because it may be harmful. For Nebivolol, there are several conditions where it is not recommended. If you have any of the following conditions, you should not take Nebivolol. Be sure to discuss your medical history with your healthcare provider, or schedule a telemedicine consultation with one of our providers to review your treatment plan.

1. Severe bradycardia (slow heart rate): Nebivolol can further slow your heart rate, which may be dangerous if you already have a slow heart rate.
2. Heart block greater than first degree: This condition delays or blocks electrical signals in your heart. Nebivolol can worsen this, leading to more serious heart rhythm problems.
3. Severe liver impairment: Nebivolol is processed by the liver. If your liver is not functioning well, the medication may accumulate in your body, leading to harmful effects.
4. Cardiogenic shock: This condition occurs when the heart suddenly can’t pump enough blood to meet the body’s needs. Nebivolol can worsen this by lowering blood pressure and heart rate.
5. Severe asthma or chronic obstructive pulmonary disease (COPD): Nebivolol can narrow the airways, worsening breathing problems in people with asthma or COPD.
6. Allergic reactions to Nebivolol: If you have had an allergic reaction to Nebivolol or any of its ingredients, you should not take this medication.

Drug to Drug Interactions

Certain medications may interact with Nebivolol, potentially increasing side effects or reducing its effectiveness. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some examples of drugs that may interact with Nebivolol:

1. Amiodarone (Pacerone): Used to treat irregular heartbeats, combining it with Nebivolol can increase the risk of bradycardia (a slow heart rate).
2. Clonidine (Catapres): This medication for high blood pressure, when taken with Nebivolol, can cause a significant drop in blood pressure.
3. Digoxin (Lanoxin): A heart medication that can raise the risk of a slow heart rate when used alongside Nebivolol.
4. Fluoxetine (Prozac): An antidepressant that may increase Nebivolol levels in the blood, leading to heightened side effects.
5. Verapamil (Calan): A calcium channel blocker used for heart conditions, which can cause an excessive drop in heart rate when combined with Nebivolol.

Nebivolol in Pregnancy

Is it Safe to Take Nebivolol During Pregnancy?

Nebivolol is generally not recommended during pregnancy unless absolutely necessary. Beta-blockers, including Nebivolol, can reduce blood flow to the placenta, which may affect the baby’s growth and development. If you are pregnant or planning to become pregnant, it’s essential to discuss the risks and benefits of continuing Nebivolol with your healthcare provider. Our telemedicine providers are available to help you make an informed decision about your treatment during pregnancy.

Nebivolol While Breastfeeding

Is it Safe to Take Nebivolol While Breastfeeding?

It is unclear whether Nebivolol passes into breast milk. Due to the potential for serious side effects in a nursing infant, it is generally advised to avoid using Nebivolol while breastfeeding. If you are breastfeeding or planning to breastfeed, consult your healthcare provider to discuss alternative medications or treatment options. You can also schedule a telemedicine appointment with one of our providers to explore safer alternatives.

Estimated Cost of Nebivolol Medication

The cost of a 30-day supply of Nebivolol without insurance can vary depending on the dosage and the pharmacy. With a GoodRx coupon, the estimated cost for a 30-day supply of Nebivolol 5 mg tablets ranges from $15 to $30. Prices may differ, so it’s a good idea to check with your local pharmacy or use a coupon service like GoodRx for the most accurate pricing.

Possible Alternatives to Nebivolol

If Nebivolol is not suitable for you, or if you are considering alternative treatments, other medications and lifestyle changes may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to discuss these options with you.

1. Hypertension (High Blood Pressure): Alternatives include other beta-blockers like metoprolol (Lopressor) or calcium channel blockers like amlodipine (Norvasc). Lifestyle changes, such as reducing salt intake, regular exercise, and stress management, can also help lower blood pressure.
2. Heart Failure: Medications like ACE inhibitors (e.g., lisinopril) or ARBs (e.g., losartan) may be used. Lifestyle changes, including a low-sodium diet and regular physical activity, can also improve heart function.
3. Angina (Chest Pain): Alternatives include nitrates (e.g., nitroglycerin) or calcium channel blockers. Quitting smoking, reducing stress, and following a heart-healthy diet can also help manage angina.
4. Atrial Fibrillation: Other medications like amiodarone (Pacerone) or anticoagulants (e.g., warfarin) may be used. Managing stress and avoiding excessive caffeine or alcohol can also help control atrial fibrillation.
5. Tachycardia (Fast Heart Rate): Alternatives include calcium channel blockers or anti-arrhythmic drugs like flecainide (Tambocor). Reducing caffeine intake and managing stress may also help control heart rate.
6. Myocardial Infarction (Heart Attack): After a heart attack, medications like ACE inhibitors or statins may be prescribed. Lifestyle changes such as quitting smoking, eating a heart-healthy diet, and exercising regularly are crucial for recovery.
7. Coronary Artery Disease: Alternatives include statins (e.g., atorvastatin) or antiplatelet drugs (e.g., aspirin). A heart-healthy diet, regular exercise, and quitting smoking can also help manage coronary artery disease.
8. Arrhythmia: Anti-arrhythmic drugs like sotalol (Betapace) or calcium channel blockers may be used. Avoiding triggers like caffeine or stress can also help manage arrhythmias.
9. Peripheral Vascular Disease: Medications like cilostazol (Pletal) or antiplatelet drugs may be used. Regular exercise, quitting smoking, and managing cholesterol levels can also help improve blood flow.

Recent Updates on Nebivolol Research

Recent studies have explored potential benefits of Nebivolol beyond its traditional use as a beta-blocker. Some research suggests that Nebivolol may have antioxidant properties, offering additional cardiovascular protection. Ongoing studies are also investigating its effects on endothelial function (the inner lining of blood vessels), which may improve blood flow and reduce the risk of heart disease. However, more research is needed to confirm these findings. If you are interested in learning more about the latest research on Nebivolol, our telemedicine providers are available to discuss how this medication fits into your overall treatment plan.

James Kingsley

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