NebivololNebivolol hydrochloride

About Nebivolol

Nebivolol is a beta blocker: it slows the heart and lowers blood pressure, and the label lists several ways it may do so, including relaxing blood vessels, while noting that the mechanism has not been definitively established. It is labeled for high blood pressure, alone or with other blood pressure medicines; safety and effectiveness in children have not been established. Most people start at 5 mg once a day, with or without food, and the dose can be raised at two-week intervals up to 40 mg a day; dosing more often than once a day is unlikely to help. People with severely reduced kidney function or moderate liver impairment start at 2.5 mg and go up slowly, while older adults need no special adjustment.

There is no boxed warning. It must not be taken with a very slow heart rate, heart block beyond first degree, cardiogenic shock, decompensated (uncontrolled) heart failure, sick sinus syndrome without a permanent pacemaker, severe liver impairment, or an allergy to any ingredient. People with asthma or other bronchospastic disease generally should not take beta blockers. It can hide the fast heartbeat that warns of low blood sugar and the signs of an overactive thyroid, it can worsen symptoms of poor circulation in the arms or legs, and in pheochromocytoma an alpha blocker is started first. Headache and tiredness are the most common side effects; dizziness, nausea, diarrhea and trouble sleeping are also reported.

In people with coronary artery disease, stopping it suddenly can bring on severe chest pain, a heart attack or dangerous heart rhythms, so it is tapered over one to two weeks when possible; stopping suddenly can also bring on a thyroid storm in someone with an overactive thyroid. It is generally continued through surgery, and the anesthetist should know about it. Medicines that block the liver enzyme CYP2D6, such as fluoxetine, paroxetine, quinidine and propafenone, raise nebivolol levels, so the dose may need lowering. Breastfeeding is not recommended, and beta blocker use in the third trimester of pregnancy may increase the risk of low blood pressure, a slow heartbeat, low blood sugar and slowed breathing in the newborn. Byvalson, approved in 2016 as nebivolol with valsartan, is listed by the FDA as discontinued.

Taking Nebivolol

How to take it

Once a day, with or without food, at about the same time each day. Keep taking it even if you feel well; in studies its effect on blood pressure was seen within two weeks.

If you miss a dose

Take it as soon as you remember, unless it is close to the time of the next dose; then skip the missed dose and take the next one at the usual time. Do not take two doses at the same time.

Storage

At room temperature in the container it came in, tightly closed, away from excess heat and moisture, out of reach of children.

Interactions to know about

Fluoxetine, paroxetine, quinidine and propafenone raise its levels. Other beta blockers are not taken with it; verapamil, diltiazem and disopyramide can add to its effects on the heart’s pumping and conduction, and digoxin adds to the risk of a slow heartbeat. If clonidine is being stopped, nebivolol is stopped several days before the clonidine taper begins, and reserpine or guanethidine call for close monitoring.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Nebivolol differs from pharmacy to pharmacy

Generic nebivolol is rated equivalent to Bystolic, and quotes for the same generic tablet can differ between pharmacies. A prescription that names Bystolic and blocks substitution is priced as a brand.

The largest tablet is 20 mg, so a 40 mg dose means two tablets a day, and a pharmacy that prices per tablet charges for each one.

Ways to pay less for Nebivolol without insurance

• Ask for generic substitution, and make sure the prescription does not block it.
• Ask whether nebivolol is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is stable, ask for a ninety-day supply, and plan refills so you never run out.
• If it is quoted high, ask the prescriber whether metoprolol, atenolol or another older generic beta blocker would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Nebivolol

1. 1.Is my generic rated equivalent to Bystolic?
2. 2.Do any of my antidepressants or heart rhythm medicines raise its levels?
3. 3.What should I do if I run short, since I should not stop it suddenly?
4. 4.Is it safe with my asthma, diabetes or thyroid condition?

Related medications