• Heart: Slow heart rate, heart failure, low blood pressure .
• Gastrointestinal: Diarrhea, nausea, abdominal pain,constipation.
• Central Nervous System: Headache, dizziness, sleeplessness, weakness, tingling.
• Respiratory: Wheezing, cough, nasopharyngitis (inflammation of nose and throat).
• Skin: Rash.
• Metabolic: Increased level of cholesterol, and uric acid in the blood.
Others: fatigue, peripheral edema, joint pain, rash
Hypertension- 5 to 40mg once daily.
Heart failure: 1.25-10 mg once daily.
It comes as a tablet to take by mouth, with or without food once a day.
Nebivolol should not be used in patients allergic to the drug, with slow heartbeat, low cardiac output, or liver failure
Avoid abrupt withdrawal of the drug.
The drug should be used with caution if the patient is having any of these conditions:
• Occasional numbness and tingling in the fingers. • Asthma.
• Chronic obstructive pulmonary disease (COPD).
• Diabetes, since it may mask the effects of low blood sugar levels.
• Hyperthyroidism, or high thyroid hormone levels.
• Kidney or liver function problems. These patients are started with a low dose.
• Skin condition called psoriasis.
• Untreated pheochromocytoma, which is a tumor of the adrenal gland.
• Metabolic acidosis like diabetic ketoacidosis.
Avoid excess dosage.
Nebivolol may cause dizziness, do not drive a car or operate machinery while taking this medication.
Nebivolol should be avoided with:
• Other beta blockers due to additive effects.
• Other drugs with depressant effects on the heart including calcium channel blockers like amlodipine, verapamil and diltiazem, heart failure drugs digoxin or digitoxin, and drugs that normalize heart rhythm like quinidine, disopyramide, flecainide, and mexiletine. Combination with some of these drugs may be necessary in cases that cannot be controlled with a single drug.
• Antidiabetic drugs since nebivolol can block the signs and of low blood sugar levels.
• Drugs that inhibit CYP2D6 enzyme like paroxetine, fluoxetine and thioridazine, which can increase nebivolol level in the blood resulting in reduced heart rate.
• Drugs used in the treatment of asthma due to opposite effects on the bronchi.
• Non-steroidal anti-inflammatory drugs like ibuprofen and diclofenac which may block the action of nebivolol on blood pressure.
• Other drugs which reduce blood pressure due to additive effect.
• Antipsychotics like phenothiazines, barbiturates and tricyclic antidepressants due to excessive reduction in heart rate.
Oral: Store it at room temperature (20-25°C) and in an airtight container.Protect from excess heat and moisture. Keep out of reach of children.