Nebivolol

Nebivolol is a cardioselective beta-adrenergic blocker (beta-1 selective) with additional vasodilatory effects due to endothelium-derived nitric oxide. By blocking beta-1 receptors, it reduces heart rate and myocardial contractility, while the nitric oxide–mediated vasodilation lowers peripheral vascular resistance. This combination can lower blood pressure with a favorable effect on vascular function.

Indications and usage: Nebivolol is used primarily for the treatment of essential hypertension. It may be prescribed for other cardiovascular conditions in appropriate patients as determined by a clinician. Brand names include Bystolic in some markets and Nebilet in others.

Dosing and administration: In adults with hypertension, the usual starting dose is 5 mg once daily. If needed, the dose can be increased after 1–2 weeks to 10 mg, with a usual maximum of 20 mg daily. Dose adjustments may be required for hepatic impairment or interactions with other medications. The drug is taken orally, with or without food.

Pharmacokinetics: Nebivolol is well absorbed orally and is extensively metabolized by the liver. It has a relatively long elimination half-life that supports once-daily dosing in many patients. Most metabolites are excreted in the urine and feces.

Adverse effects and precautions: Common adverse effects include bradycardia, dizziness, fatigue, headache, hypotension, and nausea. Bronchospasm is less likely than with nonselective beta-blockers but caution is advised in patients with reactive airway disease. Nebivolol may mask hypoglycemia symptoms, so use in diabetes requires caution. Contraindications include severe bradycardia, second- or third-degree atrioventricular block, acute decompensated heart failure, cardiogenic shock, and known hypersensitivity. Caution is advised in hepatic impairment and when used with other antihypertensives or agents affecting conduction.