Formulary
Nebivolol: Indications, Dosing, Side Effects and Interactions
Nebivolol clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Nebivolol: Indications, Dosing, Side Effects and Interactions
Nebivolol clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Essential hypertension**
- **Adult** (By Mouth): 5 mg daily.
- **Elderly** (By Mouth): Initially 2.5 mg daily, then increased if necessary to 5 mg daily.
**Hypertension in patient with renal impairment**
- **Adult** (By Mouth): Initially 2.5 mg once daily, then increased if necessary to 5 mg once daily.
**Adjunct in stable mild to moderate heart failure**
- **Adult** (By Mouth): 70 years and over Initially 1.25 mg once daily for 1-2 weeks, then increased if tolerated to 2.5 mg once daily for 1-2 weeks, then increased if tolerated to 5 mg once daily for 1-2 weeks, then increased if tolerated to 10 mg once daily.
Cautions
For all beta-adrenoceptor blockers (systemic) Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: in combination with verapamil or diltiazem (risk of heart block) with bradycardia (heart rate less than 50 beats per minute), or second- or third-degree AV block (contra-indicated; risk of complete heart block, asystole) in diabetes mellitus patients with frequent hypoglycaemic episodes (risk of suppressing hypoglycaemic symptoms) if prescribed a non-selective beta-blocker (including topical beta-blockers) in a history of asthma requiring treatment (contra-indicated in asthma; risk of increased bronchospasm)
Contraindications
For all beta-adrenoceptor blockers (systemic) Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal's angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure Contra-indications, further information Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken. Contra-indications For nebivolol Acute or decompensated heart failure requiring intravenous inotropes
Side effects
For all beta-adrenoceptor blockers (systemic) Common or very common Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; rash (reversible on discontinuation); Raynaud's phenomenon; sleep disorders; syncope; visual impairment; vomiting Uncommon Alopecia; atrioventricular block; bronchospasm Rare or very rare Hallucination; psoriasis exacerbated Side-effects, further information With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. Overdose Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. For details on the management of poisoning, see Beta-blockers, under Emergency treatment of poisoning . Side-effects For nebivolol Common or very common Constipation; oedema; postural hypertension Uncommon Dyspepsia; flatulence; intermittent claudication; skin reactions
Interactions
**Severe interactions:**
- The concomitant use of beta-blockers with sulfonylureas could increase the risk of severe hypoglycaemia.
**Other interactions (18):**
- Combinations not recommended: Class I antiarrhythmics (quinidine, hydroquinidine, cibenzoline, flecainide, disopyramide, lidocaine, mexiletine, propafenone): effect on atrio-ventricular conduction...
- Centrally-acting antihypertensives (clonidine, guanfacin, moxonidine, methyldopa, rilmenidine): concomitant use of centrally acting antihypertensive drugs may worsen heart failure by a decrease in...
- Combinations to be used with caution : Class III antiarrhythmic drugs (Amiodarone ): effect on atrio-ventricular conduction time may be potentiated.
- The anaesthesiologist should be informed when the patient is receiving Nebivolol 1.25 mg Tablets.
- Insulin and oral antidiabetic drugs : although nebivolol does not affect glucose level, concomitant use may mask certain symptoms of hypoglycaemia (palpitations, tachycardia).
- Baclofen (antispastic agent), amifostine (antineoplastic adjunct): concomitant use with antihypertensives is likely to increase the fall in blood pressure, therefore the dosage of the...
Pregnancy
For all beta-adrenoceptor blockers (systemic) Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension.
Breast feeding
For all beta-adrenoceptor blockers (systemic) With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants. Breast feeding For nebivolol Manufacturers advise avoidance.
Hepatic impairment
Manufacturer advises avoid (limited information available).
Renal impairment
Hypertension in patient with renal impairment for nebivolol By mouth Adult Initially 2.5 mg once daily, then increased if necessary to 5 mg once daily.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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