Nebivolol

Nebivolol is a beta-1 selective beta blocker medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Treatment of high blood pressure (hypertension).
• In some patients, management of stable chronic heart failure as part of specialist-directed therapy.

Nebivolol is usually taken by mouth once daily, with or without food. The exact dose and any dose increase should be decided by the prescribing doctor, especially in older adults and in people with kidney, liver, heart, or breathing problems. Do not change the dose or stop treatment suddenly unless advised by a doctor.

• Common side effects may include headache, dizziness, tiredness, nausea, diarrhoea or constipation, and sleep disturbance.
• It may cause slow heart rate, low blood pressure, cold hands or feet, ankle swelling, shortness of breath, or worsening heart failure symptoms in susceptible people.
• Serious effects needing urgent medical help include fainting, severe dizziness, chest pain, wheezing or severe breathing difficulty, very slow heartbeat, heart block, or signs of an allergic reaction such as swelling of the face or throat.

Use Nebivolol with caution in people with asthma or chronic obstructive lung disease, diabetes, thyroid overactivity, peripheral circulation problems, kidney disease, liver disease, a history of severe allergy, psoriasis, depression, or heart rhythm/conduction problems. It can mask some warning signs of low blood sugar and overactive thyroid. Inform the doctor before surgery or anaesthesia. Use this medicine only under the guidance of a registered doctor or pharmacist.

• Other blood pressure-lowering medicines can increase the risk of dizziness, fainting, or low blood pressure.
• Verapamil, diltiazem, digoxin, amiodarone, and some other heart rhythm medicines may increase the risk of slow heart rate or heart block.
• Clonidine should not be stopped suddenly while taking a beta blocker unless directed by a doctor.
• Strong CYP2D6 inhibitors such as fluoxetine, paroxetine, quinidine, or bupropion may increase nebivolol levels and side effects.
• Insulin and oral antidiabetic medicines: nebivolol may mask symptoms of low blood sugar such as fast heartbeat.
• NSAIDs such as ibuprofen or diclofenac may reduce the blood pressure-lowering effect in some patients.
• Alcohol may increase dizziness or low blood pressure; avoid excessive alcohol.

• Known allergy to nebivolol or any component of the tablet.
• Severe slow heart rate, sick sinus syndrome, or second- or third-degree heart block unless a functioning pacemaker is present.
• Cardiogenic shock or acute/decompensated heart failure requiring intravenous inotropic support.
• Severe low blood pressure.
• Severe liver impairment.
• History of bronchospasm or severe asthma where beta blocker use is considered unsafe by the doctor.

During pregnancy, nebivolol should be used only if the doctor considers it clearly necessary, because beta blockers may affect fetal growth or cause slow heartbeat, low blood pressure, or low blood sugar in the newborn. Breastfeeding is generally not recommended unless a doctor advises otherwise, as safety data are limited and beta blockers may pass into breast milk.

Store tablets at room temperature, away from excess heat, moisture, and direct sunlight. Keep out of the reach of children and do not use after the expiry date printed on the pack.