Nebivolol: Drug information

For additional information see "Nebivolol: Patient drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: US

Bystolic

Brand Names: Canada

Bystolic;
JAMP-Nebivolol

Pharmacologic Category

Antihypertensive;
Beta-Blocker, Beta-1 Selective

Dosing: Adult

Hypertension

Hypertension (alternative agent):

Note : Not recommended in the absence of specific comorbidities (eg, ischemic heart disease or arrhythmia) (Ref).

Oral: Initial: 5 mg once daily; titrate as needed at 2-week intervals based on patient response to a maximum dose of 40 mg once daily (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

CrCl 50 to 80 mL/minute: There are no dosage adjustments provided in the manufacturer’s labeling; however, dose adjustment does not appear necessary.

CrCl 30 to 50 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling; however, dose adjustment is likely not necessary. Following a single 5 mg dose in patients with CrCl 30 to 50 mL/minute, reduction in nebivolol clearance was negligible (~17%) (Ref).

CrCl <30 mL/minute: Initial: 2.5 mg once daily; if initial response is inadequate, may increase cautiously.

Hemodialysis: There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Liver Impairment: Adult

Mild impairment (Child-Pugh class A): There are no dosage adjustments provided in the manufacturer's labeling; use caution.

Moderate impairment (Child-Pugh class B): Initial: 2.5 mg once daily; if initial response is inadequate, may increase cautiously

Severe impairment (Child-Pugh class C): Use is contraindicated.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Cardiovascular: Bradycardia (1%), chest pain (1%), peripheral edema (1%)

Dermatologic: Skin rash (1%)

Gastrointestinal: Diarrhea (3%), nausea (1% to 3%)

Nervous system: Dizziness (3% to 4%), fatigue (2% to 5%), headache (7% to 9%), insomnia (1%)

Respiratory: Dyspnea (1%)

Frequency not defined:

Endocrine & metabolic: Decreased HDL cholesterol, hypercholesterolemia, increased serum triglycerides, increased uric acid

Gastrointestinal: Abdominal pain

Hematologic & oncologic: Decreased platelet count

Nervous system: Asthenia, paresthesia

Renal: Increased blood urea nitrogen

Postmarketing:

Cardiovascular: Acute myocardial infarction, atrioventricular block (including second-degree atrioventricular block, complete atrioventricular block), claudication, hypotension, peripheral ischemia, Raynaud disease, syncope

Dermatologic: Allergic contact dermatitis (Fedele 2002), hyperpigmentation (Aslan 2017), lichenoid eruption (Bodmer 2006), pruritus, psoriasis

Endocrine & metabolic: Hyperkalemia (Altabas 2016)

Gastrointestinal: Vomiting

Genitourinary: Erectile dysfunction

Hematologic & oncologic: Thrombocytopenia

Hepatic: Abnormal liver function (including increased serum alanine aminotransferase, increased serum aspartate aminotransferase, increased serum bilirubin)

Hypersensitivity: Hypersensitivity reaction (including angioedema, hypersensitivity angiitis)

Nervous system: Drowsiness, vertigo

Neuromuscular & skeletal: Rhabdomyolysis (Notturno 2021)

Renal: Acute kidney injury

Respiratory: Acute pulmonary edema, bronchospasm

Contraindications

Hypersensitivity to nebivolol or any component of the formulation; severe bradycardia; heart block greater than first-degree (except in patients with a functioning artificial pacemaker); cardiogenic shock; decompensated heart failure; sick sinus syndrome (unless a permanent pacemaker is in place); severe hepatic impairment (Child-Pugh class C)

Canadian labeling: Additional contraindications (not in US labeling): Severe peripheral arterial circulatory disorders; sinoatrial block; rare hereditary conditions of Galactose intolerance, congenital lactase deficiency or glucose-galactose malabsorption.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactic reactions: Use caution with history of severe anaphylaxis to a variety of allergens; patients taking beta-blockers may become more sensitive to repeated challenges. Treatment of anaphylaxis (eg, epinephrine) in patients taking beta-blockers may be ineffective or promote undesirable effects.

• Hypoglycemia: Beta-blockers may mask early warning signs of hypoglycemia (eg, tachycardia) and increase the risk of severe or prolonged hypoglycemia. Patients with diabetes mellitus, children, and patients who are fasting (eg, surgery, not eating regularly, vomiting) may be at increased risk. If hypoglycemia occurs, advise patients to seek emergency medical treatment.

Disease-related concerns:

• Bronchospastic disease: In general, patients with bronchospastic disease should not receive beta-blockers; for patients with bronchospastic disease who do not respond to or cannot tolerate other therapies, initial low doses of beta₁-selective nebivolol may be employed and used cautiously with close monitoring. Ensure patient has an inhaled beta₂-agonist immediately available.

• Diabetes: Use with caution in patients with diabetes mellitus; may potentiate hypoglycemia and/or mask signs and symptoms.

• Heart failure: Nebivolol has not been shown to reduce morbidity or mortality in the general heart failure population; only beta-blockers proven to reduce mortality (ie, bisoprolol, carvedilol, or ER metoprolol succinate) should be used in the treatment of heart failure.

• Hepatic impairment: Use with caution in patients with hepatic impairment; dosage adjustment required with moderate impairment (Child-Pugh class B).

• Kidney impairment: Use with caution in patients with renal impairment; dosage adjustment required with severe renal impairment (CrCl <30 mL/minute). Nebivolol has not been evaluated in dialysis-dependent patients.

• Myasthenia gravis: Use with caution in patients with myasthenia gravis.

• Peripheral vascular disease (PVD) and Raynaud disease: May precipitate or aggravate symptoms of arterial insufficiency in patients with PVD and Raynaud disease. Use with caution and monitor for progression of arterial obstruction.

• Pheochromocytoma (untreated): Adequate alpha-blockade is required prior to use of any beta-blocker.

• Psoriasis: Beta-blocker use has been associated with induction or exacerbation of psoriasis, but cause and effect have not been firmly established.

• Thyroid disease: May mask signs of hyperthyroidism (eg, tachycardia). If hyperthyroidism is suspected, carefully manage and monitor; abrupt withdrawal may exacerbate symptoms of hyperthyroidism or precipitate thyroid storm.

• Vasospastic angina: Beta-blockers without alpha₁-adrenergic receptor blocking activity should be avoided in patients with vasospastic angina since unopposed alpha₁-adrenergic receptors mediate coronary vasoconstriction and can worsen anginal symptoms (Mayer 1998).

Special populations:

• Older adult: Bradycardia may be observed more frequently in elderly patients (>65 years of age); dosage reductions may be necessary.

Other warnings/precautions:

• Abrupt withdrawal: Beta-blocker therapy should not be withdrawn abruptly (particularly in patients with coronary artery disease), but gradually tapered over 1 to 2 weeks to avoid acute tachycardia, hypertension, and/or ischemia. Severe exacerbation of angina, ventricular arrhythmias, and myocardial infarction (MI) have been reported following abrupt withdrawal of beta-blocker therapy. Temporary but prompt resumption of beta-blocker therapy may be indicated with worsening of angina or acute coronary insufficiency.

• Major surgery: Chronic beta-blocker therapy should not be routinely withdrawn prior to major surgery.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Bystolic: 2.5 mg, 5 mg, 10 mg, 20 mg [contains fd&c blue #2 (indigo carm) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake]

Generic: 2.5 mg, 5 mg, 10 mg, 20 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Bystolic Oral)

2.5 mg (per each): $7.10

5 mg (per each): $7.10

10 mg (per each): $7.68

20 mg (per each): $7.68

Tablets (Nebivolol HCl Oral)

2.5 mg (per each): $3.18 - $5.75

5 mg (per each): $3.77 - $5.75

10 mg (per each): $4.21 - $5.75

20 mg (per each): $4.74 - $5.75

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Bystolic: 2.5 mg, 5 mg, 10 mg, 20 mg [contains fd&c blue #2 (indigo carm) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake]

Generic: 5 mg

Administration: Adult

Oral: May be administered with or without food.

Use: Labeled Indications

Hypertension: Management of hypertension. Note: Beta-blockers are not recommended as first-line therapy (ACC/AHA [Whelton 2018]).

Metabolism/Transport Effects

Substrate of CYP2D6 (Major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May increase bradycardic effects of Beta-Blockers. Risk C: Monitor

Ajmaline: May increase serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Alpha2-Agonists: Beta-Blockers may increase rebound hypertensive effects of Alpha2-Agonists. This effect can occur when the Alpha2-Agonist is abruptly withdrawn. Alpha2-Agonists may increase AV-blocking effects of Beta-Blockers. Sinus node dysfunction may also be enhanced. Management: Closely monitor heart rate during treatment with a beta blocker and clonidine. Withdraw beta blockers several days before clonidine withdrawal when possible, and monitor blood pressure closely. Recommendations for other alpha2-agonists are unavailable. Risk D: Consider Therapy Modification

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Amiodarone: May increase bradycardic effects of Beta-Blockers. Possibly to the point of cardiac arrest. Amiodarone may increase serum concentration of Beta-Blockers. Risk C: Monitor

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Antidiabetic Agents: Beta-Blockers (Beta1 Selective) may increase adverse/toxic effects of Antidiabetic Agents. Specifically, beta-blockers may mask the hypoglycemic symptoms of antidiabetic agents. Risk C: Monitor

Antipsychotic Agents (Phenothiazines): May increase hypotensive effects of Beta-Blockers. Beta-Blockers may decrease metabolism of Antipsychotic Agents (Phenothiazines). Antipsychotic Agents (Phenothiazines) may decrease metabolism of Beta-Blockers. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Artemether and Lumefantrine: May increase serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Beta2-Agonists: Beta-Blockers (Beta1 Selective) may decrease bronchodilatory effects of Beta2-Agonists. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. Risk C: Monitor

Bradycardia-Causing Agents: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Cafedrine: May increase bradycardic effects of Beta-Blockers. Beta-Blockers may decrease therapeutic effects of Cafedrine. Risk C: Monitor

Cannabis: Beta-Blockers may increase adverse/toxic effects of Cannabis. Specifically, the risk of hypoglycemia may be increased. Risk C: Monitor

Ceritinib: Bradycardia-Causing Agents may increase bradycardic effects of Ceritinib. Management: If this combination cannot be avoided, monitor patients for evidence of symptomatic bradycardia, and closely monitor blood pressure and heart rate during therapy. Risk D: Consider Therapy Modification

Cholinergic Agonists: Beta-Blockers may increase adverse/toxic effects of Cholinergic Agonists. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Risk C: Monitor

CYP2D6 Inhibitors (Moderate): May increase serum concentration of Nebivolol. Risk C: Monitor

CYP2D6 Inhibitors (Strong): May increase serum concentration of Nebivolol. Risk C: Monitor

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Dipyridamole: May increase bradycardic effects of Beta-Blockers. Risk C: Monitor

Disopyramide: May increase bradycardic effects of Beta-Blockers. Beta-Blockers may increase negative inotropic effects of Disopyramide. Risk C: Monitor

DOBUTamine: Beta-Blockers may decrease therapeutic effects of DOBUTamine. Risk C: Monitor

Dronedarone: May increase bradycardic effects of Beta-Blockers. Dronedarone may increase serum concentration of Beta-Blockers. This likely applies only to those agents that are metabolized by CYP2D6. Management: Use lower initial beta-blocker doses; adequate tolerance of the combination, based on ECG findings, should be confirmed prior to any increase in beta-blocker dose. Increase monitoring for clinical response and adverse effects. Risk D: Consider Therapy Modification

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

EPHEDrine (Systemic): Beta-Blockers may decrease therapeutic effects of EPHEDrine (Systemic). Risk C: Monitor

EPINEPHrine (Nasal): Beta-Blockers (Beta1 Selective) may decrease therapeutic effects of EPINEPHrine (Nasal). Risk C: Monitor

EPINEPHrine (Oral Inhalation): Beta-Blockers (Beta1 Selective) may decrease therapeutic effects of EPINEPHrine (Oral Inhalation). Risk C: Monitor

EPINEPHrine (Systemic): Beta-Blockers (Beta1 Selective) may decrease therapeutic effects of EPINEPHrine (Systemic). Risk C: Monitor

Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): Beta-Blockers may increase vasoconstricting effects of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk C: Monitor

Etilefrine: Beta-Blockers may decrease therapeutic effects of Etilefrine. Etilefrine may increase bradycardic effects of Beta-Blockers. Risk C: Monitor

Etofylline: Beta-Blockers may decrease therapeutic effects of Etofylline. Risk X: Avoid

Etrasimod: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Fexinidazole: Bradycardia-Causing Agents may increase arrhythmogenic effects of Fexinidazole. Risk X: Avoid

Fingolimod: Bradycardia-Causing Agents may increase bradycardic effects of Fingolimod. Management: Consult with the prescriber of any bradycardia-causing agent to see if the agent could be switched to an agent that does not cause bradycardia prior to initiating fingolimod. If combined, perform continuous ECG monitoring after the first fingolimod dose. Risk D: Consider Therapy Modification

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Grass Pollen Allergen Extract (5 Grass Extract): Beta-Blockers may increase adverse/toxic effects of Grass Pollen Allergen Extract (5 Grass Extract). More specifically, Beta-Blockers may inhibit the ability to effectively treat severe allergic reactions to Grass Pollen Allergen Extract (5 Grass Extract) with epinephrine. Some other effects of epinephrine may be unaffected or even enhanced (e.g., vasoconstriction) during treatment with Beta-Blockers. Management: Consider alternatives to either grass pollen allergen extract (5 grass extract) or beta-blockers in patients with indications for both agents. Canadian product labeling specifically lists this combination as contraindicated. Risk D: Consider Therapy Modification

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Isocarboxazid: May increase antihypertensive effects of Antihypertensive Agents. Risk X: Avoid

Isoproterenol: Beta-Blockers may decrease therapeutic effects of Isoproterenol. Risk C: Monitor

Ivabradine: Bradycardia-Causing Agents may increase bradycardic effects of Ivabradine. Risk C: Monitor

Lacosamide: Bradycardia-Causing Agents may increase AV-blocking effects of Lacosamide. Risk C: Monitor

Landiolol: Bradycardia-Causing Agents may increase bradycardic effects of Landiolol. Risk X: Avoid

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Mavacamten: Beta-Blockers may increase adverse/toxic effects of Mavacamten. Specifically, negative inotropic effects may be increased. Risk C: Monitor

Mavorixafor: May increase serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk X: Avoid

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methacholine: Beta-Blockers may increase adverse/toxic effects of Methacholine. Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Midodrine: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Mivacurium: Beta-Blockers may increase therapeutic effects of Mivacurium. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

NIFEdipine (Topical): May increase adverse/toxic effects of Beta-Blockers. Risk C: Monitor

NIFEdipine: May increase hypotensive effects of Beta-Blockers. NIFEdipine may increase negative inotropic effects of Beta-Blockers. Risk C: Monitor

Nitrendipine: May increase therapeutic effects of Beta-Blockers. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Beta-Blockers. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease antihypertensive effects of Beta-Blockers. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

Opipramol: Beta-Blockers may increase serum concentration of Opipramol. Opipramol may increase serum concentration of Beta-Blockers. Risk C: Monitor

Ozanimod: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Patiromer: May decrease serum concentration of Nebivolol. Management: Administer nebivolol at least 3 hours before or 3 hours after patiromer. Risk D: Consider Therapy Modification

Peginterferon Alfa-2b: May decrease serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Ponesimod: Bradycardia-Causing Agents may increase bradycardic effects of Ponesimod. Management: Avoid coadministration of ponesimod with drugs that may cause bradycardia when possible. If combined, monitor heart rate closely and consider obtaining a cardiology consult. Do not initiate ponesimod in patients on beta-blockers if HR is less than 55 bpm. Risk D: Consider Therapy Modification

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Reserpine: May increase hypotensive effects of Beta-Blockers. Reserpine may increase bradycardic effects of Beta-Blockers. Risk C: Monitor

Rivastigmine: May increase bradycardic effects of Beta-Blockers. Risk X: Avoid

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Siponimod: Bradycardia-Causing Agents may increase bradycardic effects of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. If combined, consider obtaining a cardiology consult regarding patient monitoring. Risk D: Consider Therapy Modification

Succinylcholine: Beta-Blockers may increase neuromuscular-blocking effects of Succinylcholine. Risk C: Monitor

Tasimelteon: Beta-Blockers may decrease therapeutic effects of Tasimelteon. Management: Consider avoiding nighttime administration of beta-blockers during tasimelteon therapy due to the potential for reduced tasimelteon efficacy. Risk D: Consider Therapy Modification

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Theodrenaline: May increase bradycardic effects of Beta-Blockers. Beta-Blockers may decrease therapeutic effects of Theodrenaline. Risk C: Monitor

Theophylline Derivatives: Beta-Blockers (Beta1 Selective) may decrease bronchodilatory effects of Theophylline Derivatives. Risk C: Monitor

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

White Birch Allergen Extract: Beta-Blockers may increase adverse/toxic effects of White Birch Allergen Extract. Specifically, beta-blockers may reduce the effectiveness of beta-agonists that may be required to treat systemic reactions to white birch allergen extract. Risk X: Avoid

Reproductive Considerations

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be used in patients trying to conceive. Nebivolol is not considered a preferred agent for use in pregnant patients; consider transitioning to a preferred agent in patients planning to become pregnant (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019).

Erectile dysfunction is noted in product labeling following use of nebivolol. As a class, outcomes from available studies evaluating beta-blockers and sexual dysfunction are inconsistent, and the negative effects on erectile function are considered controversial. A clear relationship between use of beta-blockers and erectile dysfunction has not been established. Some reports suggest nebivolol has a lower incidence of sexual dysfunction and may be beneficial for use in patients who report this adverse event with other beta-blockers. Hypertension itself is associated with erectile dysfunction. Patients on a beta-blocker presenting with sexual dysfunction should be evaluated for underlying disease (Farmakis 2021; Levine 2012; Semet 2017; Terentes-Printzios 2022; Viigimaa 2020).

Pregnancy Considerations

Outcome data following maternal use of nebivolol in pregnancy are limited (Humenna 2019; Sullo 2015).

Exposure to beta-blockers during pregnancy may increase the risk for adverse events in the neonate. If maternal use of a beta-blocker is needed, monitor fetal growth during pregnancy; monitor the newborn for 48 hours after delivery for bradycardia, hypoglycemia, and respiratory depression (ESC [Regitz-Zagrosek 2018]).

Chronic maternal hypertension is also associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 2019).

Patients with preexisting hypertension may continue their medication during pregnancy unless contraindications exist (ESC [Regitz-Zagrosek 2018]). When treatment of hypertension is initiated during pregnancy, agents other than nebivolol may be preferred (ACOG 2019; ESC [Cífková 2020]; ESC [Regitz-Zagrosek 2018]; SOGC [Magee 2022]).

Breastfeeding Considerations

It is not known if nebivolol is present in breast milk.

Breastfeeding is not recommended by the manufacturer due to the potential for beta-blockers to produce serious effects on breastfed infants, especially bradycardia. Use of a beta-blocker other than nebivolol may be preferred in lactating patients (ESC [Cífková 2020]).

Monitoring Parameters

BP, heart rate, ECG; serum glucose (in diabetic patients); signs and symptoms of bronchospasm in patients with existing bronchospastic disease; mental alertness.

Reference Range

BP goal: May vary depending on clinical conditions, different clinical practice guidelines, and expert opinion. Refer to "Clinical Practice Guidelines" for specific treatment goals.

Mechanism of Action

Highly-selective inhibitor of beta₁-adrenergic receptors; at doses ≤10 mg nebivolol preferentially blocks beta₁-receptors. Nebivolol, unlike other beta-blockers, also produces an endothelium-derived nitric oxide-dependent vasodilation resulting in a reduction of systemic vascular resistance.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Rapid

Distribution: V_d: 8 to 12 L/kg

Protein binding: ~98%, primarily to albumin

Metabolism: Hepatic; via glucuronidation and CYP2D6; extensive first-pass metabolism to multiple active metabolites with variable activity

Bioavailability: ~12% (extensive metabolizers); 96% (poor metabolizers) (Mangrella 1998)

Half-life elimination: Terminal: 12 hours (extensive metabolizers) or 19 hours (poor metabolizers); up to 32 hours has been reported in poor metabolizers (Mangrella 1998)

Time to peak, plasma: 1.5 to 4 hours

Excretion: Urine (extensive metabolizers: 38%; poor metabolizers: 67%; <0.5% of total dose as unchanged drug); feces (extensive metabolizers: 44%; poor metabolizers: 13%; <0.5% of total dose as unchanged drug)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Clearance was unchanged in patients with mild renal impairment and was reduced negligibly in patients with moderate renal impairment. However, clearance was reduced by 53% in patients with severe renal impairment.

Hepatic function impairment: C_max increases 3-fold, AUC increases 10-fold, and apparent clearance decreases 86% in patients with moderate hepatic impairment.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Nebicor | Nebilet | Nebistar;
(AR) Argentina: Corpres | Gadocor | Moban | Nabila | Nebibloc | Nebicor | Nebilet | Nebivolol denver farma | Nebix | Neoblock | Nidib | Nirpol | Syncrocor;
(AT) Austria: Hypoloc | Nebacop | Nebilan | Nebivolol | Nebivolol 1a pharma | Nebivolol accord | Nebivolol actavis | Nebivolol G.L. | Nebivolol genericon | Nebivolol ratiopharm | Nebivolol sandoz | Nebivolol stada | Nomexor;
(AU) Australia: Apo nebivolol | Nebilet | Nebivolol lupin | Nebivolol sandoz | Nepiten;
(BD) Bangladesh: Bipinor | Cardoneb | Carnovas | Dystolic | Ivolol | Maxineb | Nebicard | Nebifast | Nebilol | Nebinor | Nebipres | Nebipro | Nebiren | Nebita | Vasocor;
(BE) Belgium: Hypoloc | Nebivolol ab | Nebivolol actavis | Nebivolol Apotex | Nebivolol EG | Nebivolol krka | Nebivolol Mylan | Nebivolol ratiopharm | Nebivolol sandoz | Nebivolol Teva | Nobiten;
(BG) Bulgaria: Bivolet | Bravylol | Cardiostad | Dublock | Nebacop | Nebicard | Nebicor | Nebilan | Nebilet | Nebivocon | Nebivolol | Nebivolol actavis | Nebivolol ratiopharm | Nebivolol Teva | Nebizita | Nevolen;
(BR) Brazil: Bivolet | Cloridrato de nebivolol | Lobeat | Lobivon | Nebic | Nebilet | Nebipre | Nebitah | Neblock | Teubiliv;
(CH) Switzerland: Nebilet | Nebivolol actavis | Nebivolol Axapharm | Nebivolol Helvepharm | Nebivolol mepha | Nebivolol sandoz | Nebivolol spirig | Nebivolol Streuli | Nebivolol Teva | Nebivolol zentiva;
(CI) Côte d'Ivoire: Nebilong | Nebinox | Temerit;
(CL) Chile: Anfibol | Doox | Nabila | Nebilet | Nebivitae | Nevobi | Pertium;
(CO) Colombia: Carvolol | Nabila | Nebilet | Nebilol | Nebivolol | Nebivolol mk | Neviten;
(CR) Costa Rica: Anfibol | Xase;
(CZ) Czech Republic: Nebilet | Nebivolol aurovitas | Nebivolol sandoz | Nolibeta;
(DE) Germany: Lobivon | Nebilet | Nebivolol Acino | Nebivolol actavis | Nebivolol AL | Nebivolol Glenmark | Nebivolol Heumann | Nebivolol puren | Nebivolol ratiopharm | Nebivolol stada;
(DO) Dominican Republic: Anfibol | Cipres | Nabila | Nabudol | Nebibrit | Nebilet | Nebipres | Nebiv | Nebivitae | Nebivolol | Nebivolol sandoz | Pertium;
(EC) Ecuador: Anfibol | Nabila | Nebicor | Nebilet | Nebilol | Nebpress | Nebpress forte | Pertium;
(EE) Estonia: Lovispes | Nebicard | Nebilet | Nebiphar | Nebispes | Nebiten | Nebivolol Orion | Nebivolol Portfarma | Nebivolol ratiopharm | Nebivolol stada | Nebivolol Teva;
(EG) Egypt: Mavilor | Modulol | Nebasco | Nebicard | Nebilet | Nebimoun | Nepvol | Nevilob | Symbian;
(ES) Spain: Insucor | Lobivon | Nebivolol Apotex | Nebivolol aurovitas | Nebivolol Cinfa | Nebivolol combix | Nebivolol Edigen | Nebivolol kern pharma | Nebivolol krka | Nebivolol Mylan | Nebivolol Normon | Nebivolol Pensa | Nebivolol ratiopharm | Nebivolol sandoz | Nebivolol stada | Nebivolol tarbis | Nebivolol Tevagen | Nebivolol viso farmaceutica | Nebivolol Winthrop | Silostar;
(ET) Ethiopia: Nebivolol;
(FI) Finland: Hypoloc | Nebilet | Nebivolol accord | Nebivolol Orion;
(FR) France: Hypoloc | Nebilox | Nebivolol actavis | Nebivolol almus | Nebivolol Arrow | Nebivolol Biogaran | Nebivolol cristers | Nebivolol Dci | Nebivolol EG | Nebivolol evolugen | Nebivolol isomed | Nebivolol krka | Nebivolol Mylan | Nebivolol Qualimed | Nebivolol Ranbaxy | Nebivolol ratiopharm | Nebivolol sandoz | Nebivolol Teva | Nebivolol Winthrop | Nebivolol Zydus | Nevibolol Dci | Temerit;
(GB) United Kingdom: Hypoloc | Nebilet | Nebivolol | Nebivolol Pliva | Nebivolol sandoz | Nebivolol Teva;
(GR) Greece: Bivol | Hypoloc | Lobibeta | Lobivon | Nebicur | Nebivolol Teva | Nebivolol/Generics | Nozac;
(HK) Hong Kong: Nebilet;
(HR) Croatia: Nebilet | Nebivolol Pliva | Nebyol | Nibel | Vibolol | Volone;
(HU) Hungary: Esteban | Ezocem | Nebacop | Nebaletor | Nebibeta | Nebiblock | Nebilet | Nebispes | Nebitrix | Nebivep | Nebivogen | Nebivolol 1 A Pharma | Nebivolol Ratiopham | Nebivolol sandoz | Nebivolol Teva | Nevotens;
(ID) Indonesia: Nebilet | Nevodio;
(IE) Ireland: Nebilet | Nebimel | Nebivolol accord | Nebivolol Teva | Nebol | Nelet;
(IN) India: Betalol | Endolol | Nabitis | Nebesel | Nebest | Nebi | Nebicard | Nebicip | Nebilife | Nebilol | Nebilong | Nebimax | Nebinex | Nebinorm | Nebipil | Nebiring | Nebistar | Nebitab | Nebiten | Nebitime | Nebitroy | Nebizok | Nebrol | Nebula | Nebycare | Nevelol | Nevol | Niavas | Nodon | Nubeta | Nuxol | Pine | Zinebi;
(IT) Italy: Lobivon | Nebilox | Nebiscon | Nebivololo | Nebivololo actavis | Nebivololo Agenerico | Nebivololo Alter | Nebivololo angenerico | Nebivololo awp | Nebivololo doc generici | Nebivololo dr reddy's | Nebivololo eg | Nebivololo Germed | Nebivololo KRKA | Nebivololo myl | Nebivololo Pensa | Nebivololo Ranbaxy | Nebivololo Ratiopharm | Nebivololo sandoz | Nebivololo teva | Nebivololo Winthrop | Nivolon | Nobistar;
(JO) Jordan: Nebilet;
(KE) Kenya: Nebi | Nebibio | Nebicard | Nebiem | Nebilet | Nebiloc | Nebilong | Nebiring | Nebiton | Nebivi | Nebtas | Nevol | Nodon;
(KR) Korea, Republic of: Nebibeta | Nebilet | Nebilol | Nebistar | Nebistol | Nebitlol | Nevetrol | Nevican | Neviolet | Nevolmin | Nevotron;
(KW) Kuwait: Nebilet;
(LB) Lebanon: Blovek | Nebicip n | Nebilet | Nebivolol Biogaran | Neviloc;
(LT) Lithuania: Nebilet | Nebinorm | Nebiphar | Nebispes | Nebiten | Nebivolol Aconitum | Nebivolol Orion | Nebivolol Portfarma | Nebivolol ratiopharm | Nebivolol stada | Nebivolol Teva | Nebivolol Torrent | Nemirostad | Nemont | Nerose;
(LU) Luxembourg: Nebivolol EG | Nebivolol Hexal | Nobiten;
(LV) Latvia: Nebilet | Nebiphar | Nebiten | Nebivolol actavis | Nebivolol krka | Nebivolol Orion | Nebivolol Portfarma | Nebivolol Ratiopharma | Nebivolol stada;
(MA) Morocco: Nebilet;
(MX) Mexico: Batensiar | Coretel n | Dubila | Lobivon | Nebivolol | Temerit | Temitev;
(MY) Malaysia: Nebicard | Nebilet | Nevodio | Nodon;
(NG) Nigeria: Nebivolol | Nodon;
(NL) Netherlands: Lobivon | Nebilet | Nebivolol | Nebivolol accord | Nebivolol actavis | Nebivolol Apotex | Nebivolol aurobindo | Nebivolol Glenmark | Nebivolol Mylan | Nebivolol PCH | Nebivolol ratiopharm | Nebivolol sandoz;
(NO) Norway: Hypoloc | Nebivolol;
(PE) Peru: Anfibol | Nabila | Nebiem | Nebilet | Nebipress | Pertium | Viboloxx;
(PH) Philippines: Bivolol | Nebicar | Nebicard | Nebil | Nebilet | Toricard;
(PK) Pakistan: Anvol | Betanorm | Bevis | Bistolic | Bmiv | Bynevol | Byvas | Byvol | Danlol | Nabiloc | Nabilox | Nebicare | Nebicor | Nebifix | Nebil | Nebilol | Nebimap | Nebiv | Nebivol | Nebiwrd | Nebix | Nebmax | Nebol | Neobiv | Nevo | Nib | Nibovo | Nobu | Voloxo;
(PL) Poland: Daneb | Ebivol | Emzok | Ezocem | Ivineb | Nebicard | Nebicon | Nebilenin | Nebilet | Nebinad | Nebispes | Nebivas | Nebivolek | Nebivolol aurovitas | Nebivolol genoptim | Nebivolol krka | Nebivor | Nedal;
(PR) Puerto Rico: Bystolic | Nebivolol;
(PT) Portugal: Blokat | Hypoloc | Nebilet | Nebivolol | Nebivolol actavis | Nebivolol ciclum | Nebivolol generis | Nebivolol germed | Nebivolol gp | Nebivolol krka | Nebivolol labesfal | Nebivolol mepha | Nebivolol ratiopharm | Nebivolol sandoz | Nebivolol tecnigen | Nebivolol Teva | Nebivolol tolife;
(PY) Paraguay: Anfibol | Antalgico | Betadine | Binest | Doox | Etibloker | Nabila | Nebivolol bioteng | Nebivolol dallas | Nebivolol heisecke | Nebivolol pasteur | Nebivolol prosalud | Nebivolol quimfa | Neblix | Nebuterol | Nevicar | Nirpol | Pertium;
(QA) Qatar: Nebilet;
(RO) Romania: Ezocem | Nebivolol aurobindo | Nebivolol Teva | Nolet | Voxnebin | X Pressol;
(RU) Russian Federation: Binelol | Bivotenz | Nebicor | Nebicor adipharm | Nebilan lannacher | Nebilet | Nebilong | Nebivator | Nebivolol | Nebivolol canon | Nebivolol chaikafarma | Nebivolol nanolek | Nebivolol sandoz | Nebivolol stada | Nebivolol Teva | Nebivolol velpharm | Nevotens | Od Neb;
(SA) Saudi Arabia: Bivoneb | Nebilet;
(SE) Sweden: Hypoloc;
(SG) Singapore: Nebilet;
(SI) Slovenia: Massido | Nebispes | Nebivolol Teva | Neldivex;
(SK) Slovakia: Nebilet | Nebitrix | Nebivolol krka | Tevaneb;
(SR) Suriname: Nebivolol aurobindo;
(TH) Thailand: Bilkate | Nebilet;
(TN) Tunisia: Nebicard | Nebicor | Nebilet | Nebilus | Nebipress;
(TR) Turkey: Bivol | Bloxer | Naksen | Nevimol | Nexivol | Valende | Vascura | Vasilol | Vasoxen;
(TW) Taiwan: Nebilet | Nebipress | Synbeta;
(UA) Ukraine: Nebiar | Nebilet | Nebilong | Nebimac | Nebitens | Nebitrend | Nebival | Nebivolol | Nebivolol sandoz | Nebivolol-darnitsa | Nebiworld | Onorio;
(UG) Uganda: Nebi | Nebiem | Nebilet | Nebilong | Nebimac | Nebivolol sandoz | Nebtas | Nebunta | Nodon;
(UY) Uruguay: Nebibloc | Neblic | Syncrocor;
(VE) Venezuela, Bolivarian Republic of: Anfibol | Nabila | Nebicard | Nebilet | Nebinox | Relnex | Tonervol | Vanzel;
(VN) Viet Nam: Bivolcard | Khouma | Smabelol;
(ZA) South Africa: Lovispes | Nebilet;
(ZM) Zambia: Nebicard | Nebilong | Nodon;
(ZW) Zimbabwe: Nebicard | Nebiem

Altabas K, Altabas V, Gulin T. Nebivolol induced hyperkalemia: case report. Acta Clin Croat. 2016;55(4):663-666. doi:10.20471/acc.2016.55.04.20 [PubMed 29117660]
American College of Obstetricians and Gynecologists (ACOG). ACOG practice bulletin no. 203: chronic hypertension in pregnancy. Obstet Gynecol. 2019;133(1):e26-e50. [PubMed 30575676]
Aslan AN, Güney MC, Akçay M, Keleş T, Bozkurt E. Lichenoid type cutaneous hyperpigmentation induced by nebivolol. Turk Kardiyol Dern Ars. 2017;45(3):268-270. doi:10.5543/tkda.2016.02151 [PubMed 28429695]
Bodmer M, Egger SS, Hohenstein E, Beltraminelli H, Krähenbühl S. Lichenoid eruption associated with the use of nebivolol. Ann Pharmacother. 2006;40(9):1688-1690. doi:10.1345/aph.1H094 [PubMed 16896017]
Brauchli YB, Jick SS, Curtin F, et al, “Association Between Beta-Blockers, Other Antihypertensive Drugs and Psoriasis: Population-Based Case-Control Study,” Br J Dermatol, 2008, 158(6):1299-307. [PubMed 18410416]
Brixius K, Bundkirchen A, Bolck B, et al, “Nebivolol, Bucindolol, Metoprolol and Carvedilol are Devoid of Intrinsic Sympathomimetic Activity in Human Myocardium,” Br J Pharmacol, 20, 133(8):1330-8. [PubMed 11498519]
Bystolic (nebivolol) [prescribing information]. North Chicago, IL: AbbVie Inc; August 2024.
Bystolic (nebivolol) [product monograph]. St-Laurent, Ontario, Canada: AbbVie Corporation; November 2022.
Cazzola M, Noschese P, D’Amato M, Det al, “Comparison of the Effects of Single Oral Doses of Nebivolol and Celiprolol on Airways in Patients With Mild Asthma,” Chest, 2000, 118(5):1322-6. [PubMed 11083681]
Cheymol G, Woestenborghs R, Snoeck E, et al. “Pharmacokinetic Study and Cardiovascular Monitoring of Nebivolol in Normal and Obese Subjects,” Eur J Clin Pharmacol, 1997, 51(6):493-8. [PubMed 9112066]
Cífková R, Johnson MR, Kahan T, et al. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother. 2020;6(6):384-393. doi:10.1093/ehjcvp/pvz082 [PubMed 31841131]
Dahlof B, Devereux RB, Kjeldsen SE, et al; Life Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359(9311):995-1003. [PubMed 11937178]
Farmakis IT, Pyrgidis N, Doundoulakis I, Mykoniatis I, Akrivos E, Giannakoulas G. Effects of major antihypertensive drug classes on erectile function: a network meta-analysis. Cardiovasc Drugs Ther. Published online May 4, 2021. doi:0.1007/s10557-021-07197-9
Fedele R, Ricciardi L, Mazzeo L, Isola S. Allergic contact dermatitis to nebivolol. Allergy. 2002;57(9):864-865. doi:10.1034/j.1398-9995.2002.23575_8.x [PubMed 12169193]
Fogari R, Zoppi A, Lazzari P, et al, “Comparative Effects of Nebivolol and Atenolol on Blood Pressure and Insulin Sensitivity in Hypertensive Subjects With Type II Diabetes,” J Hum Hypertens, 1997, 11(11):753-7. [PubMed 9416986]
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi: 10.1210/jc.2015-4061. [PubMed 26934393]
Go AS, Bauman M, King SM, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention [published online November 15, 2013]. Hypertension. [PubMed 24243703]
Humenna IY, Heryak SN, Dobryanska VY. Rational control of arterial pressure during labor in women with arterial hypertension. Ginekol Pol. 2019;90(4):206-211. doi:10.5603/GP.2019.0037 [PubMed 31059113]
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. [PubMed 24352797]
Juul AB, Wetterslev J, Gluud C, et al, “Effect of Perioperative Beta Blockade in Patients With Diabetes Undergoing Major Non-Cardiac Surgery: Randomized Placebo Controlled, Blinded Multicentre Trial. DIPOM Trial Group,” BMJ, 2006, 332(7556):1482. [PubMed 16793810]
Kamali F, Howes A, Thomas SHL, et al, “A Pharmacokinetic and Pharmacodynamic Interaction Study Between Nebivolol and the H2-Receptor Antagonists Cimetidine and Ranitidine,” Br J Clin Pharmacol, 1997, 43(2):201-4. [PubMed 9131955]
Lang DM, “Anaphylactoid and Anaphylactic Reactions. Hazards of Beta-Blockers,” Drug Saf, 1995, 12(5):299-304. [PubMed 7669259]
Levine GN, Steinke EE, Bakaeen FG, et al; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Quality of Care and Outcomes Research. Sexual activity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2012;125(8):1058-1072. doi:10.1161/CIR.0b013e3182447787 [PubMed 22267844]
Lindenauer PK, Pekow P, Wang K, et al, "Perioperative Beta-Blocker Therapy and Mortality After Major Noncardiac Surgery," N Engl J Med, 2005, 353(4):349-61. [PubMed 16049209]
Magee LA, Smith GN, Bloch C, et al. Guideline no. 426: hypertensive disorders of pregnancy: diagnosis, prediction, prevention, and management. J Obstet Gynaecol Can. 2022;44(5):547-571.e1. doi:10.1016/j.jogc.2022.03.002 [PubMed 35577426]
Mangrella M, Rossi F, Fici F, et al, “Pharmacology of Nebivolol,” Pharmacol Res, 1998, 38(6):419-31. [PubMed 9990650]
Mayer S, Hillis LD. Prinzmetal's variant angina. Clin Cardiol. 1998;21(4):243-246. doi:10.1002/clc.4960210403 [PubMed 9562933]
National Institute for Health and Care Excellence (NICE). NICE guideline: hypertension in pregnancy: diagnosis and management. http://www.nice.org.uk/guidance/ng133/. Updated June 25, 2019. Accessed December 1, 2022.
Nishimura RA, Otto CM, Bonow RO, et al, 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-92. doi: 10.1161/CIR.0000000000000029. [PubMed 24589852]
Notturno F, Uncini A. Association of rhabdomyolysis with nebivolol. Muscle Nerve. 2021;63(1):E1-E2. doi:10.1002/mus.27078 [PubMed 32981086]
Nuttall SL, Routledge HC, and Kendall MJ, “A Comparison of the Beta1–Selectivity of Three Beta1–Selective Beta-Blockers,” J Clin Pharm Ther, 2003, 28(3):179-86. [PubMed 12795776]
Patrianakos AP, Parthenakis FI, Mavrakis HE, et al, “Comparative Efficacy of Nebivolol versus Carvedilol on Left Ventricular Function and Exercise Capacity in Patients With Non-Ischemic Cardiomyopathy. A 12-Month Study,” Am Heart J, 2005, 150(5):985. [PubMed 16290981]
POISE Study Group, Devereaux PJ, Yang H, et al, “Effects of Extended-Release Metoprolol Succinate in Patients Undergoing Non-Cardiac Surgery (POISE Trial): A Randomised Controlled Trial,” Lancet, 2008, 371(9627):1839-47. [PubMed 18479744]
Prisant LM, “Nebivolol: Pharmacologic Profile of an Ultraselective, Vasodilatory [Beta]1–Blocker,” J Clin Pharm, 2008, 48(2):225-39. [PubMed 18083889]
Redelmeier D, Scales D, and Kopp A, "Beta Blockers for Elective Surgery in Elderly Patients: Population Based, Retrospective Cohort Study," BMJ, 2005, 331(7522):932. [PubMed 16210252]
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-3241. [PubMed 30165544]
Rosendorff C, Lackland DT, Allison M, et al. Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Soc Hypertens. 2015;9(6):453-498. doi: 10.1016/j.jash.2015.03.002. Epub 2015 Mar 31. [PubMed 25840695] 10.1016/j.jash.2015.03.002
Schön MP and Boehncke WH, “Psoriasis,” N Eng J Med, 2005, 352(18):1899-1912. [PubMed 15872205]
Semet M, Paci M, Saïas-Magnan J, et al. The impact of drugs on male fertility: a review. Andrology. 2017;5(4):640-663. doi:10.1111/andr.12366 [PubMed 28622464]
Shaw AA, liu S, Zachwiega LF, et al. Effects of varying degrees of renal impairment on the pharmacokinetic disposition of nebivolol. Clinical Pharmacology & Therapeutics. 2005;77(2):38.
Smith SC Jr, Benjamin EJ, Bonow RO, et al, “AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline From the American Heart Association and American College of Cardiology Foundation,” Circulation, 2011, 124(22):2458-73. [PubMed 22052934]
Sullo MG, Perri D, Sibilio M, et al. Hypoglycemia, polycythemia and hyponatremia in a newborn exposed to nebivolol during pregnancy. J Pharmacol Pharmacother. 2015;6(1):45-48. [PubMed 25709355]
Terentes-Printzios D, Ioakeimidis N, Rokkas K, Vlachopoulos C. Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nat Rev Cardiol. 2022;19(1):59-74. doi:10.1038/s41569-021-00593-6 [PubMed 34331033]
UK Prospective Diabetes Study Group, “Efficacy of Atenolol and Captopril in Reducing Risk of Macrovascular and Microvascular Complications in Type 2 Diabetes: UKPDS 39,” BMJ, 1998, 317(7160):713-20. [PubMed 9732338]
Viigimaa M, Vlachopoulos C, Doumas M, et al; European Society of Hypertension Working Group on Sexual Dysfunction. Update of the position paper on arterial hypertension and erectile dysfunction. J Hypertens. 2020;38(7):1220-1234. doi:10.1097/HJH.0000000000002382 [PubMed 32073535]
Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119. doi:10.1161/CIR.0000000000001168 [PubMed 37471501]
Weber MA, Schiffrin EL, White WB, et al, Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich). 2014;16(1):14-26. [PubMed 24341872]
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71(6):1269-1324. doi:10.1161/HYP.0000000000000066 [PubMed 29133354]
Yang H, Raymer K, Butler R, et al, “The Effects of Perioperative Beta-Blockade: Results of the Metoprolol After Vascular Surgery (MaVS) Study, a Randomized Controlled Trial,” Am Hear J, 2006, 152(5):983-90. [PubMed 17070177]

Topic 9461 Version 476.0

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Nebivolol: Drug information