Nebivolol is indicated in the treatment of essential hypertension and adjunct in stable
mild to moderate heart failure in patients over 70 years.
DOSAGE AND ADMINISTRATION
Hypertension: 5 mg daily; elderly initially 2.5 mg daily, increased if necessary to 5 mg
daily. Adjunct in heart failure: Initially 1.25 mg once daily, then if tolerated increased at
intervals of 1–2 weeks to 2.5 mg once daily, then to 5 mg once daily, then to max. 10
mg once daily.
Nebivolol is contraindicated in the following conditions: severe bradycardia, heart
block greater than first degree, patients with cardiogenic shock, decompensated
cardiac failure, sick sinus syndrome, patients with severe hepatic impairment, patients
who are hypersensitive to any component of this product.
The most common side effects are headache, nausea and bradycardia.
Use caution when Nebivolol is co-administered with CYP2D6 inhibitors (quinidine,
propafenone, fluoxetine, paroxetine, etc.). Do not use Nebivolol with other β-blockers,
both digitalis glycosides and β-blockers slow atrioventricular conduction and decrease
heart rate. Concomitant use can increase the risk of bradycardia, Nebivolol can
exacerbate the effects of myocardial depressants or inhibitors of AV conduction, such
as certain calcium antagonists (verapamil and diltiazem), or antiarrhythmic agents,
such as disopyramide.
USE IN PREGNANCY AND LACTATION
β-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and
bradycardia; the risk is greater in severe hypertension. If beta-blockers are used close
to delivery, infants should be monitored for signs of β-blockade. Nebivolol is advised
to avoid during breast-feeding due to possible risk of toxicity due to β-blockade.
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