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Nebivolol, Oral Tablet

Highlights for Nebivolol

  1. Nebivolol oral tablet is available as a brand-name drug. It does not have a generic version. Brand name: Bystolic.
  2. Nebivolol comes as a tablet you take by mouth.
  3. Nebivolol is used to treat high blood pressure (hypertension). It can be taken alone or in combination with other blood pressure medications.
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Important warnings

Important warnings

  • Stopping this drug suddenly warning: If you have a history of heart problems and you’ve been taking nebivolol, stopping it suddenly may result in serious side effects. These side effects can include new or worsened chest pain (angina), an irregular heart rate, and even a heart attack. Never stop taking this medication without talking with your doctor first. To stop taking this drug, your doctor will need to decrease your dosage slowly over 1–2 weeks.
  • Low blood sugar warning: This drug can make some of the symptoms of low blood sugar (hypoglycemia) difficult to recognize. This is especially true if the symptom is a fast heart rate. If you take insulin or other anti-diabetic medications, you may need to monitor your blood sugar level more closely.

About

What is nebivolol?

Nebivolol is a prescription drug. It’s available as an oral tablet under the brand name Bystolic. It’s not available as a generic drug.

This drug may be taken as part of a combination therapy with other drugs used for high blood pressure.

Why it's used

Nebivolol is used to treat high blood pressure. Lowering your blood pressure will help reduce your chance of having a stroke or heart attack.

How it works

This drug belongs to a class of drugs called beta-blockers. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Beta-blockers work by relaxing your blood vessels. This reduces the workload on your heart and slows down your heart rate. This helps to lower your blood pressure.

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Side effects

Nebivolol side effects

Nebivolol oral tablet may cause tiredness. Avoid driving or using heavy machinery until you know how this drug affects you.

This drug can also cause other side effects.

More common side effects

The more common side effects that can occur with nebivolol include:

  • dizziness
  • tiredness
  • a slower heart rate
  • headache
  • diarrhea
  • nausea

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Chest pain
  • Very slow heart rate. Symptoms can include:
    • extreme tiredness
    • severe dizziness
    • lightheadedness
    • fainting
  • Swelling of your hands, arms, legs, ankles, or feet
  • Trouble breathing, or shortness of breath
  • Rash

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Interactions

Nebivolol may interact with other medications

Nebivolol oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with nebivolol are listed below.

Depression drugs

If you take nebivolol and certain depression drugs together, the amount of nebivolol in your body may get too high. This can lead to increased side effects of nebivolol. Examples of these drugs include:

  • fluoxetine
  • paroxetine

Heart drugs

When nebivolol is used with certain heart drugs, your heart rate can become very slow. Examples of these drugs include:

  • digoxin
  • verapamil
  • diltiazem
  • disopyramide

Irregular heart rhythm drugs

If you take nebivolol with certain drugs used to treat irregular heart rhythms, the amount of nebivolol in your body may get too high. This can lead to increased side effects of nebivolol. Examples of these drugs include:

  • quinidine
  • propafenone

Other high blood pressure drugs

Beta-blockers: These drugs should not be taken with nebivolol. Taking them together can greatly slow down your heart rate. Examples of beta-blockers include:

  • acebutolol
  • atenolol
  • betaxolol
  • bisoprolol
  • carvedilol
  • esmolol
  • labetalol
  • metoprolol
  • nadolol
  • penbutolol
  • pindolol
  • propranolol
  • timolol

Alpha-blockers: Taking these drugs with nebivolol can cause an increased risk of low blood pressure when you stand (orthostatic hypotension). This can cause lightheadedness and dizziness. Examples of alpha-blockers include:

  • doxazosin
  • prazosin
  • terazosin

Catecholamine-depleting drugs: Taking these drugs with nebivolol can greatly slow down your heart rate. Examples of catecholamine-depleting drugs include:

  • reserpine
  • guanethidine

Clonidine: If you’re taking clonidine with nebivolol but need to stop taking it because your blood pressure is getting too low, your doctor will first stop your nebivolol treatment for several days before your clonidine treatment is stopped.

When clonidine is stopped, rebound high blood pressuretypically occurs. This means your blood pressure can get high again. This can be much worse if nebivolol is not stopped several days before you stop taking clonidine.

Sildenafil

If you take nebivolol and sildenafil (Viagra) together, the amount of sildenafil in your body may decrease. This can lead to decreased effects of sildenafil.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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Other warnings

Nebivololwarnings

This drug comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction, causing symptoms such as:

  • trouble breathing or swallowing
  • swelling of your throat or tongue
  • hives
  • rash

Call 911 or go to the nearest emergency room if you develop these symptoms.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

Using alcohol while taking this drug can cause a sedative effect (slowed reflexes, poor judgment, sleepiness). This effect can worsen the drowsiness that’s common with nebivolol.

Warnings for people with certain health conditions

For people with heart problems: You shouldn’t take nebivolol if you have the following conditions:

Taking nebivolol can worsen heart failure. It can also slow your heart rate down to a rate that is unsafe.

For people with circulation problems: This drug can worsen peripheral vascular disease. Talk to your doctor before using this drug if you have a history of circulation problems.

For people with breathing problems: This drug can make breathing more difficult for you. Talk to your doctor before using nebivolol if you have any breathing problems such as asthma or chronic obstructive pulmonary disease (COPD).

For people with diabetes: This drug can mask some of the signs of low blood sugar, especially fast heart rate. If you take insulin or other diabetes drugs, you may need to monitor your daily blood sugar level more closely.

For people with an overactive thyroid gland: This drug may mask the signs and symptoms of an overactive thyroid gland (hyperthyroidism), such as a fast heart rate. If this drug is stopped suddenly, your symptoms of hyperthyroidism may get much worse. You may need urgent medical attention. Tell your doctor if you have any thyroid problems before starting this medication.

For people with an adrenal gland tumor: Let your doctor know if you have an adrenal gland tumor (pheochromocytoma). These tumors can make your blood pressure very difficult to control. Your doctor may need to start you on a different drug known as an alphablocker before starting you on nebivolol.

For people with liver disease: This drug is processed by your liver. If your liver isn’t working properly, more of the drug can stay in your body longer and put you at risk for side effects. If you have liver disease, discuss it with your doctor before taking this drug.

For people with kidney disease: This drug is removed from your body by your kidneys. If your kidneys aren’t working properly, more of the drug can stay in your body longer and put you at risk for side effects. If you have kidney disease, discuss it with your doctor before taking this drug.

Warnings for other groups

For pregnant women: This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Speak with your doctor if you’re pregnant or planning to become pregnant. Nebivolol should only be used during pregnancy if the potential benefit justifies the potential risk to your pregnancy.

For women who are breastfeeding: It isn’t known if nebivolol passes into breast milk. If it does, there’s a possibility for serious side effects in children who breastfeed from mothers taking this drug. These side effects include a very slow heart rate. Because of these risks, you should nottake nebivolol while breastfeeding.

For children: This drug hasn’t been studied in children. It shouldn’t be used in people younger than 18 years.

For people having surgery: Before your procedure, be sure to tell your surgeon that you’re taking nebivolol. They will need to monitor your heart rate closely during surgery.

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Dosage

How to take nebivolol

All possible dosages and forms may not be included here. Your doctor will tell you what dosage is right for you. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Dosage for high blood pressure (hypertension)

Brand: Bystolic

  • Form: oral tablet
  • Strengths: 2.5 mg, 5 mg, 10 mg, 20 mg

Adult dosage (ages 18 years and older)

  • The usual starting dosage is 5 mg once per day.
  • Your doctor will adjust your dosage based on how you respond to this drug. These dosage adjustments should be at least 2 weeks apart.
  • The maximum recommended dosage is 40 mg once per day.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children and shouldn’t be used by people younger than 18 years.

Special dosage considerations

  • For people with severe kidney disease: The recommended starting dosage for people with severe kidney disease is 2.5 mg once per day. Your doctor will increase your dosage slowly if needed. This drug hasn’t been studied in people on dialysis. If you’re on dialysis, your doctor will monitor you more closely.
  • For people with liver disease: The recommended starting dosage for people with moderate liver disease is 2.5 mg once per day. Your doctor will increase your dosage slowly if needed. This drug isn’t recommended for people who have severe liver disease.

Dosage warnings

If you need to stop taking nebivolol, your doctor should decrease your dosage slowly over a period of 1–2 weeks.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

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Take as directed

Take as directed

Nebivolol is used for long-term treatment. It comes with serious risks if you don't take it as prescribed.

If you don't take it at all: Your high blood pressure may get worse. You may have a higher chance of a heart attack or stroke.

If you stop taking it suddenly: Don’t stop taking this drug suddenly. This may lead to new or worsened chest pain (angina), an irregular heart rate, and even a heart attack. You’re at higher risk for these effects if you already have a heart problem. If you need to stop taking this drug, your doctor will slowly decrease your dosage over 1–2 weeks.

If you don't take it on schedule: You should take this drug according to the schedule your doctor gives you, because you need to have a consistent amount of this drug in your body for the drug to work right. If you don’t take it on schedule, the drug may not work well.

If you take too much: Taking too much of this drug may cause severe side effects such as very low blood pressure (hypotension), a dangerously slow heart rate (bradycardia), heart failure, trouble breathing, extreme tiredness, dizziness, or very low blood sugar that could even lead to a coma. If you take too much nebivolol, call your doctor or go to the nearest hospital emergency department right away.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember, unless you remember just a few hours before the time for your next dose. Then only take one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: High blood pressure doesn’t always have symptoms that you may be able to recognize, so you won’t be able to feel if this medication is working. But if you measure your blood pressure at home, you should see it decrease. Your doctor will also monitor your blood pressure to make sure this medication is working for you.

Important considerations

Important considerations for taking nebivolol

Keep these considerations in mind if your doctor prescribes nebivolol for you.

General

  • You can take this drug with or without food.
  • Take this drug at the same time every day.
  • You can crush or cut the tablet.

Storage

  • Store this drug at room temperature between 68°F and 77°F (20°C and 25°C).
  • Don’t freeze this medication.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

Your doctor may ask you to measure your daily blood pressure at home between office visits to see how well your blood pressure is being controlled. You may need to buy your own blood pressure monitor.

Clinical monitoring

Your doctor will monitor your blood pressure and heart rate regularly. Your doctor also will do routine blood tests to check how well your liver and kidneys are working and to make sure nebivolol is still safe for you to take.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Hidden costs

You may need to buy your own blood pressure monitor. Home blood pressure monitors are available for purchase at most pharmacies.

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

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Alternatives

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained here in is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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