Generic Nebivolol (Nebivolol )

Introduction

Nebivolol is a medication primarily prescribed to manage high blood pressure and, in some cases, heart failure. It belongs to a class of drugs known as beta-blockers, specifically a third-generation beta-blocker that is highly selective for beta-1 receptors. Available as a pill in dosages of 2.5mg, 5mg, and 10mg, Nebivolol works by relaxing blood vessels and slowing the heart rate, thereby reducing the workload on the heart and lowering blood pressure. It is sometimes prescribed for secondary uses including anxiety-related cardiovascular symptoms.

Quick Reference Facts

Active Ingredient

Nebivolol

Form

pill 2.5mg | 5mg | 10mg

Primary and Off-Label Uses

Hypertension, Heart Failure, Anxiety-related Cardiovascular Symptoms (Off-label)

What is Nebivolol?

Nebivolol is a selective beta-1 adrenergic receptor antagonist, commonly referred to as a beta-blocker. It is a third-generation beta-blocker, distinguishing it from older classes with unique properties contributing to its efficacy and tolerability. Nebivolol is the generic version of medications containing the active compound Nebivolol. It is marketed under brand names such as Bystolic and is available as the generic equivalent of Bystolic. Nebivolol is a white to off-white crystalline powder that is practically insoluble in water and sparingly soluble in ethano

How Nebivolol Works

Nebivolol exerts its therapeutic effects through a dual mechanism. Primarily, it acts as a highly selective beta-1 adrenergic receptor blocker. By selectively antagonising beta-1 receptors, which are predominantly found in the heart, Nebivolol reduces the stimulating effects of adrenaline and noradrenaline on the heart. This leads to a decrease in heart rate, a reduction in the force of cardiac contractions, and a subsequent lowering of blood pressure.

Beyond its beta-blocking activity, Nebivolol also possesses a unique vasodilating property mediated by the nitric oxide pathway. It stimulates the production and release of nitric oxide (NO) from the endothelium, the inner lining of blood vessels. Nitric oxide is a potent vasodilator, meaning it causes blood vessels to relax and widen, which further contributes to lowering blood pressure and improving blood flow. This combination of reduced cardiac output and peripheral vasodilation makes Nebivolol an effective antihypertensive agent. The onset of action for Nebivolol is typically within a few hours of administration, with peak effects observed after several weeks of consistent dosing. It is metabolised in the liver and excreted via both urine and faeces.

Conditions Treated with Nebivolol

Nebivolol is primarily approved for the management of hypertension (high blood pressure) and, in eligible patients, for the treatment of mild to moderate chronic heart failure.

• Hypertension (High Blood Pressure): By blocking beta-1 receptors in the heart and promoting vasodilation, Nebivolol effectively reduces systemic vascular resistance and cardiac workload. This leads to a sustained lowering of blood pressure, which is crucial for preventing serious cardiovascular complications such as stroke, heart attack, and kidney problems. Its selective action helps to minimise some of the side effects commonly associated with less selective beta-blockers.

• Chronic Heart Failure: In patients with chronic heart failure, Nebivolol is used as an add-on therapy to standard treatments. It is initiated at a low dose and gradually titrated upwards. In this context, Nebivolol helps to improve the heart's pumping efficiency over time, reduce hospitalisation rates for worsening heart failure, and improve overall survival. The vasodilating properties may also play a role in its benefits for heart failure by reducing the afterload on the heart.

Is Nebivolol the Right Medication for You?

Nebivolol is generally considered a good option for adult patients diagnosed with hypertension who require effective blood pressure control. Its high selectivity for beta-1 receptors makes it a potentially favourable choice for individuals who might be more susceptible to side effects like bronchoconstriction, which can occur with non-selective beta-blockers. This selectivity is particularly beneficial for patients with respiratory conditions like asthma or COPD, although caution is still advised.

For patients with stable, mild to moderate chronic heart failure, Nebivolol, when initiated by a healthcare professional and carefully titrated, can be an important part of their treatment regimen. It is typically prescribed to patients who are already on standard heart failure medications, such as ACE inhibitors, ARBs, or beta-blockers.

However, Nebivolol may not be suitable for everyone. It is contraindicated in individuals with severe bradycardia (very slow heart rate), heart block greater than first degree, cardiogenic shock, decompensated cardiac failure, sick sinus syndrome, or severe hepatic impairment. Patients with peripheral vascular disease or Raynaud's phenomenon should use it with caution. It is also important for individuals to disclose their full medical history, including any allergies, other medical conditions, and all other medications they are taking, to their healthcare provider to determine if Nebivolol is an appropriate and safe choice.

Buying Nebivolol from Our Online Pharmacy

Why Choose Our Service?

Our online pharmacy service provides a convenient and accessible channel for individuals seeking Nebivolol. We understand that managing chronic conditions like hypertension and heart failure requires consistent access to medication, and we aim to provide a reliable solution for obtaining Nebivolol. Our platform is designed to offer a straightforward process for acquiring your necessary treatments, ensuring you can maintain your health regimen without undue stress or barriers.

Quality & Safety Assurance

We are committed to ensuring the quality and authenticity of the medications we supply. We partner with licensed international pharmacies to ensure quality and authenticity. These partners operate under recognised regulatory frameworks, adhering to stringent quality control measures. This allows us to provide access to Nebivolol that meets high standards of safety and efficacy, giving you confidence in the medication you receive.

Pricing & Access

A significant benefit of using our service is competitive pricing. We aim to make essential medications like Nebivolol more affordable. For patients looking for generic options, Nebivolol is a cost-effective alternative to its branded counterparts, offering the same therapeutic benefits at a lower price point. This accessibility is crucial for individuals managing long-term health conditions where ongoing medication costs can be substantial.

Discreet Delivery

We prioritise your privacy and convenience. All orders are processed with the utmost discretion, and medications are shipped in plain, unmarked packaging to ensure your privacy is protected. We offer reliable delivery options, with express delivery typically within 7 days or standard airmail in approximately 3 weeks, ensuring you receive your Nebivolol promptly and discreetly.

Use: Dosing, Missed Dose, Overdose

Dosing

The dosage of Nebivolol is determined by a healthcare professional based on the individual's condition, response to treatment, and tolerance. Typical starting doses and titration schedules are as follows:

• Hypertension: The usual starting dose is 5mg once daily. Depending on the blood pressure response, the dose may be increased in increments of 5mg every 1-2 weeks, up to a maximum recommended dose of 40mg per day. However, for many patients, doses between 5mg and 20mg are sufficient.
• Heart Failure: For chronic heart failure, Nebivolol therapy is initiated at a very low dose of 1.25mg once daily. The dose is then gradually increased at intervals of no less than two weeks to 2.5mg, then 5mg, and finally to the target dose of 10mg once daily, provided the patient tolerates the medication without worsening of heart failure symptoms or haemodynamic instability.

Nebivolol pills are typically taken once daily, with or without food. It is important to maintain a consistent daily schedule for optimal therapeutic effect.

Missed Dose

If you miss a dose of Nebivolol, take it as soon as you remember, unless it is almost time for your next scheduled dose. If it is close to the time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. It is important to follow your healthcare provider's instructions regarding missed doses. If you are unsure, consult your pharmacist or doctor.

Overdose

An overdose of Nebivolol can lead to severe consequences, including profound hypotension, bradycardia, heart block, dizziness, fatigue, tremors, and potentially cardiac arrest. If you suspect an overdose, seek immediate medical attention. Contact your local emergency services or go to the nearest emergency room. If you are able, try to bring the medication packaging with you to provide information about the substance ingested, even if it is an expired product.

Practical Precautions

• Alcohol: Alcohol can enhance the blood pressure-lowering effects of Nebivolol, potentially leading to dizziness and lightheadedness. It is advisable to limit alcohol consumption while taking this medication.
• Operating Machinery: While your body adjusts to Nebivolol, you may experience dizziness or fatigue. Avoid tasks requiring alertness, such as driving or operating heavy machinery, until you know how the medication affects you.
• Administration: Nebivolol is usually taken as a single daily dose. It can be taken with or without food, but consistency in administration time is beneficial.

Safety Information

⚠️ Who Should Not Take Nebivolol

Nebivolol is contraindicated in individuals with the following conditions:

• Severe Bradycardia: An abnormally slow heart rate.
• Heart Block greater than First Degree: A condition where electrical signals in the heart are significantly delayed or blocked.
• Sick Sinus Syndrome: A disorder affecting the heart's natural pacemaker.
• Cardiogenic Shock: A life-threatening condition where the heart suddenly can't pump enough blood to the body.
• Decompensated Cardiac Failure: Worsening or acute heart failure requiring hospitalisation or intravenous treatment.
• Severe Hepatic Impairment: Significant liver dysfunction.
• Known Hypersensitivity: Allergy to nebivolol or any component of the medication.
• Asthma or Bronchospasm: While Nebivolol is selective, caution is still advised, and it may be contraindicated in severe cases.

Common Side Effects

Many patients tolerate Nebivolol well, but some common side effects may occur, particularly during the initial phase of treatment. These tend to be mild and often diminish as your body adjusts:

• Headache: A frequent, usually mild, and temporary side effect.
• Dizziness or Lightheadedness: Often related to the blood pressure-lowering effects.
• Fatigue: A feeling of tiredness or lack of energy.
• Nausea: Mild stomach upset.
• Slowed Heart Rate (Bradycardia): Due to the medication's effect on the heart.
• Peripheral Oedema: Swelling in the ankles or feet.

If any of these side effects are persistent or bothersome, consult your healthcare provider.

Serious Side Effects (Seek Immediate Medical Help)

While rare, serious side effects can occur. Seek immediate medical attention if you experience any of the following:

• Signs of severe bradycardia: Extreme dizziness, fainting, or slow pulse.
• Worsening Heart Failure: Increased shortness of breath, rapid weight gain, swelling of legs or feet, unusual fatigue.
• Severe Allergic Reaction (Anaphylaxis): Rash, itching or swelling (especially of the face, tongue, throat), severe dizziness, trouble breathing.
• Low Blood Pressure (Hypotension): Symptoms may include severe dizziness, fainting, blurred vision.
• Bronchospasm: Difficulty breathing, especially in individuals with pre-existing respiratory conditions.
• Liver problems: Yellowing of the skin or eyes (jaundice), dark urine, stomach pain, persistent nausea or vomiting.

Drug & Food Interactions

Nebivolol can interact with various medications and substances, altering its effectiveness or increasing the risk of side effects. Always inform your healthcare provider and pharmacist about all medications, supplements, and herbal products you are using.

• Other Antihypertensives: Taking Nebivolol with other blood pressure-lowering medications can enhance its effects, potentially leading to excessive hypotension.
• Calcium Channel Blockers (e.g., Verapamil, Diltiazem): Concurrent use may increase the risk of bradycardia and heart block.
• Antiarrhythmics (e.g., Quinidine, Amiodarone): Can increase the risk of bradycardia and conduction disturbances.
• Certain Antidepressants (e.g., SSRIs, SNRIs): Some antidepressants can increase nebivolol levels or its effects.
• Antifungals (e.g., Fluconazole): May inhibit the metabolism of nebivolol, leading to increased levels.
• Certain HIV Protease Inhibitors: Can also inhibit nebivolol metabolism.
• Cimetidine: May increase nebivolol concentrations.
• Alcohol: As mentioned, alcohol can potentiate the hypotensive effects.
• Grapefruit Juice: While less commonly cited for Nebivolol compared to other drugs, it's prudent to discuss significant grapefruit consumption with your doctor.

Off-Label and Investigational Uses of Nebivolol

While approved for hypertension and chronic heart failure, Nebivolol is sometimes used in clinical practice or explored in research for other cardiovascular conditions. These uses have not been formally approved by regulatory bodies and should only be considered under strict medical supervision.

• Anxiety-Related Cardiovascular Symptoms: Nebivolol's ability to reduce heart rate and block the physical manifestations of adrenaline, such as palpitations and tremors, may make it useful in managing the cardiovascular symptoms associated with anxiety or panic attacks. Studies and clinical experience suggest it can help mitigate the stress response on the cardiovascular system.

• Pulmonary Arterial Hypertension (PAH): Some preliminary research has investigated Nebivolol's potential role in treating PAH, potentially due to its vasodilatory effects, though its efficacy and role in this complex condition are still under investigation and not established as a standard treatment.

• Perioperative Hypertension: It has been used to manage elevated blood pressure around the time of surgery, though its use in this context requires careful consideration of patient stability and potential interactions with anaesthetic agents.

It is crucial for patients considering Nebivolol for any off-label purpose to have a thorough discussion with their healthcare provider about the potential benefits, risks, and the lack of formal regulatory approval for such uses.

Storage & Handling

Nebivolol pills should be stored at room temperature, typically between 20°C and 25°C (68°F and 77°F). Protect the medication from excessive heat and light. Keep it in its original container to protect it from moisture. Ensure the container is tightly closed when not in use.

Do not store Nebivolol in the bathroom or near a sink, as humidity can degrade the medication. If your medication has passed its expiry date, it should not be used. Consult your local pharmacy or local authority for proper disposal methods for unused or expired medications; do not flush them down the toilet or dispose of them in household waste.

Frequently Asked Questions

About Using Nebivolol

• Can I take Nebivolol with grapefruit juice? While Nebivolol is generally considered to have a lower risk of interaction with grapefruit juice compared to some other medications, it is still advisable to discuss significant consumption patterns with your healthcare provider or pharmacist. Some individuals may be more sensitive to potential alterations in medication metabolism.

• Is it safe to take Nebivolol while traveling across time zones? When travelling across time zones, it is generally recommended to continue taking Nebivolol at the same time relative to your body's new schedule. If you find it difficult to maintain a consistent time, consult your healthcare provider or pharmacist for personalised advice on adjusting your dosing schedule.

• Can I split Nebivolol pills to get a lower dose? Whether Nebivolol pills can be split depends on the specific formulation and dosage. Some tablets are scored and designed to be split, while others are not. Always check the packaging or consult your pharmacist before splitting any medication to ensure it is safe and accurate.

Product Information

• What do Nebivolol pills look like? Nebivolol tablets are typically round and white to off-white in colour. They may be imprinted with a dosage strength and a manufacturer's identifier. The exact appearance can vary slightly between generic manufacturers.

• Are there any inactive ingredients in Nebivolol I should be aware of? Nebivolol pills contain several inactive ingredients, which can vary depending on the manufacturer. Common inactive ingredients may include microcrystalline cellulose, lactose, croscarmellose sodium, povidone, and magnesium stearate. If you have specific allergies or sensitivities, it is important to review the product leaflet or consult your pharmacist.

Safety & Regulations

• Will Nebivolol show up on a drug test? Nebivolol is a prescription cardiovascular medication and is not typically tested for on standard recreational drug screening tests. However, it is a controlled substance, and its presence could be identified on advanced or specific forensic testing if required for medical reasons.

• Can I take Nebivolol if I have diabetes? Nebivolol can be used by individuals with diabetes, but caution is advised. Like other beta-blockers, it can mask some of the warning symptoms of low blood sugar (hypoglycaemia), such as rapid heart rate. Patients with diabetes should monitor their blood glucose levels closely and discuss any concerns with their healthcare provider.

• What are the risks of taking Nebivolol if I have kidney disease? While Nebivolol is a medication that can be used cautiously in mild to moderate kidney disease, its use in severe renal impairment requires careful dose adjustment and medical supervision. The kidneys play a role in its elimination, and impaired function can lead to higher drug levels.

Scientific & Clinical Curiosity

• How does Nebivolol compare to older beta-blockers like Atenolol? Nebivolol is a third-generation beta-blocker that is highly selective for beta-1 receptors and also possesses vasodilatory properties via nitric oxide. In contrast, older beta-blockers like Atenolol are more cardio-selective but lack significant vasodilatory action, and less selective beta-blockers can affect beta-2 receptors in the lungs and blood vessels, potentially causing more side effects.

• What is the typical duration of action for Nebivolol? Nebivolol has a relatively long half-life, contributing to its once-daily dosing. Its therapeutic effects on blood pressure are sustained throughout the 24-hour dosing period, with peak effects on blood pressure sometimes taking several weeks of consistent therapy to become fully apparent.

Glossary

Beta-1 Receptors

Specific receptors in the body, primarily located in the heart, that are targeted by beta-blocker medications to slow heart rate and reduce contractility.

Vasodilation

The widening of blood vessels, which allows blood to flow more easily and can lower blood pressure.

Nitric Oxide (NO)

A molecule produced in the body that plays a role in vasodilation and cardiovascular health. Nebivolol stimulates its release.

Hypertension

The medical term for high blood pressure, a condition where the force of blood against artery walls is consistently too high.

Heart Failure

A chronic condition where the heart muscle doesn't pump blood as well as it should, leading to various symptoms like shortness of breath and fatigue.

Disclaimer

The information presented regarding Nebivolol is intended for general educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. All health-related decisions, including the use of Nebivolol for its approved indications or any off-label applications, must be made under the direct supervision of a qualified healthcare provider. We assume that all individuals accessing this information are responsible adults capable of understanding and making informed choices about their health. Our pharmacy service acts as a facilitator for accessing Nebivolol for those who may face challenges with availability or cost through traditional channels, including the provision of generic alternatives. Always consult your doctor or another qualified health professional with any questions you may have regarding a medical condition before starting, altering, or discontinuing any medication.