Nebivolol | Side Effects, Dosage, Uses & More
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Generic Name:

nebivolol, Oral tablet

All Brands

  • Bystolic
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Highlights for nebivolol

Oral tablet
1

Nebivolol is an oral tablet used to treat hypertension (high blood pressure). It can be taken alone or in combination with other blood pressure medications. 

2

The usual starting dose is 5 mg, taken once per day.

3

You shouldn’t use nebivolol if you have a slow heartbeat or certain types of irregular heartbeats, severe liver damage, or you’re allergic to any ingredient in this drug.

4

If you take nebivolol, don’t stop taking it without speaking with your doctor first. If you have a history of heart problems, suddenly stopping nebivolol may lead to new or worsened chest pain (angina), an irregular heart rate, and even a heart attack.

5

Your doctor may ask you to keep a daily log of your blood pressure while you take this drug.

IMPORTANT INFORMATION

Stopping this drug suddenly

If you have a history of heart problems and you’ve been taking nebivolol, stopping it suddenly may result in serious side effects, including new or worsened chest pain (angina), an irregular heart rate, and even a heart attack. Never stop taking this medication without speaking with your doctor first. Your doctor will need to decrease your dose slowly over 1–2 weeks.

Low blood sugar (hypoglycemia)

This drug can make some of the symptoms of low blood sugar 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.

What is nebivolol?

This drug is a prescription drug that’s available as an oral tablet. It’s not available as a generic drug.

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

Why it's used

This drug 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.

More Details

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. They’re 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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nebivolol Side Effects

Oral tablet

More Common Side Effects

The more common side effects that occur with nebivolol include:

  • dizziness

  • tiredness

  • a slower heart rate

  • headache

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 any of these serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

  • Chest pain

  • Very slow heart rate. Symptoms can include:

    • extreme tiredness
    • severe dizziness
    • lightheadedness
    • fainting
  • Swelling of your hands, arms, legs, ankles, and feet

  • Difficulty breathing or shortness of breath

  • Rash

Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug may cause tiredness. Avoid driving or operating heavy machinery until you know how this drug affects you.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot 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.
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nebivolol May Interact with Other Medications

Oral tablet

Nebivolol can interact with other medications, herbs, or vitamins you might be taking. An interaction is when a substance changes the way a drug works. This can be harmful or cause the drugs that you take to not work as well. To help prevent interactions, your doctor should manage all of your medications carefully. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

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

Medications that might interact with this drug

Certain depression drugs

If you take nebivolol and these 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. These drugs include:

  • digoxin
  • verapamil
  • diltiazem
  • disopyramide

Certain irregular heart rhythm drugs

If you take nebivolol and these 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:

  • 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
    • esmolol
    • metoprolol
    • nadolol
    • penbutolol
    • pindolol
    • propranolol
    • timolol
  • Alpha-blockers: Taking these drugs together with nebivolol can cause an increased risk of low blood pressure when you stand (orthostatic hypotension), which can cause lightheadedness and dizziness. Examples of alpha-blockers include:
    • doxazosin
    • prazosin
    • terazosin
  • Catecholamine-depleting drugs: Taking these drugs together with nebivolol can greatly slow down your heart rate. Examples of catecholamine-depleting drugs include:
    • reserpine
    • guanethidine
  • Clonidine: If you’re also 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 for several days before clonidine is stopped. Typically when clonidine is stopped, rebound hypertension occurs. This can be much worse if nebivolol is not stopped several days before clonidine

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot 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.
Drug warnings
heart problems
People with heart problems

You shouldn’t take nebivolol if you have the following conditions:

  • cardiogenic shock (when your heart isn’t able to pump enough blood to the rest of your body)
  • unstable heart failure
  • second or third degree heart block
  • extremely slow heart rate

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

circulation problems
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.

breathing problems
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).

diabetes
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.

overactive thyroid gland
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.

adrenal gland tumor
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 alpha-blocker before starting you on nebivolol.

liver disease
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. Talk to your doctor before taking this drug if you have liver disease.

kidney disease
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. Talk to your doctor before using this drug if you have kidney disease.

pregnant women
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 fetus.

breastfeeding
Women who are breast-feeding

It isn’t known if nebivolol passes into breast milk. If it does, there’s a possibility for serious side effects in infants who breast-feed from mothers taking this drug. These side effects include a very slow heart rate. If you wish to breast-feed. You should talk to your doctor before taking this drug.

for children
For children

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

allergies
Allergies

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

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

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

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How to Take nebivolol (Dosage)

Oral tablet

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

What are you taking this medication for?

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 dose is 5 mg, once per day.
  • Your doctor will adjust your dose based on how you respond to this drug. These dosage adjustments should be at least 2 weeks apart.
  • The maximum recommended dose is 40 mg per day.
Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used by people younger than18 years.

Special considerations

Severe kidney disease: The recommended starting dose for people with kidney disease is 2.5 mg, once per day. Your doctor will increase your dose 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.

Liver disease: The recommended starting dose for people with moderate liver disease is 2.5 mg, once per day. Your doctor will increase your dose slowly if needed. This drug isn’t recommended for people who have severe liver disease.

Warnings

If you need to stop taking nebivolol, your doctor should decrease your dose 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 cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug comes with serious risks if you don't take it as prescribed.

If you don't take it at all

If you decide not to take this drug, your high blood pressure may get worse. You 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 dose 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, difficulty 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 toxic side effects.

How to tell if the drug is working

High blood pressure doesn’t always have signs or 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.

This drug is used for long-term treatment.

Important considerations for taking this drug
take with or without food
You can take this drug with or without food
timing
Take this drug at the same time every day
can crush or cut
You can crush or cut the tablet
storage
Store this drug at room temperature
See Details
refillable
Prescription is refillable
See Details
travel
Travel
See Details
self-management
Self-management
See Details
clinical monitoring
Clinical monitoring
See Details
not usually stocked
Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead
hidden costs
Hidden costs
See Details
prior authorization
Insurance
See Details

Store this drug at room temperature

  • Keep it from 68°F to 77°F (20°C to 25°C).
  • Don’t freeze this medication.
  • Keep it away from high temperature.
  • Keep your drugs away from areas where they could get wet, such as bathrooms. Store these drugs away from moisture and damp locations.

Prescription 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 medicine in your glove compartment or leave it in the car, especially when the temperature is hot or freezing.

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 monitoring machine. Home blood pressure monitors are available for purchase at most pharmacies.

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 make sure nebivolol is still safe for you to take.

Hidden costs

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

Insurance

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.

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.

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How Much Does nebivolol Cost?

Oral tablet

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Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on September 30, 2015

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 herein 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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