Nebivolol: uses, doses, side effects and cautions

According to the UK patient leaflet, nebivolol is a selective beta-blocking agent. It prevents the heart rate from rising, controls the strength of the heart's pumping and dilates blood vessels, which together lower blood pressure.

It is licensed to treat raised blood pressure and, together with standard therapy, stable mild to moderate chronic heart failure in patients aged 70 years or older. It is a prescription medicine.

For high blood pressure the usual adult dose is one 5 mg tablet daily, preferably at the same time of day. People with reduced kidney function, and patients over 65, usually start with 2.5 mg daily and may increase to 5 mg if needed.

In heart failure the dose is increased slowly, at one to two week intervals depending on tolerability, through 1.25 mg, 2.5 mg and 5 mg to a maximum of 10 mg once daily. Treatment is started under close supervision, and regular monitoring is expected at the start. Always follow the instructions on your own prescription.

The leaflet and SmPC list allergy to nebivolol, low blood pressure, serious circulation problems, a very slow heartbeat, certain heart rhythm disorders such as sick sinus syndrome or heart block without a pacemaker, acute heart failure or heart failure needing intravenous support, cardiogenic shock, asthma or a history of bronchospasm, untreated phaeochromocytoma, liver dysfunction and metabolic acidosis.

Like other beta blockers, nebivolol can mask the warning signs of low blood sugar in people with diabetes and increase the risk of severe hypoglycaemia with some diabetes medicines. It can also mask symptoms of an overactive thyroid and intensify allergic reactions. Tell an anaesthetist before surgery, and take care in peripheral circulation disorders.

Abrupt discontinuation should be avoided, particularly in people with heart disease. Talk to your prescriber before stopping.

The most frequently reported effects are headache, dizziness, tiredness, a slow heart rate, low blood pressure, diarrhoea, constipation, nausea, shortness of breath and swelling of the hands or feet. The SmPC notes these appear most often in people treated for hypertension.

Tell your prescriber about anything that bothers you or does not settle. Seek urgent help for signs of allergic reaction, fainting or severe breathlessness.

Combinations to avoid include class I antiarrhythmics, calcium channel blockers such as verapamil and diltiazem, and centrally acting antihypertensives. Care is needed with amiodarone, amlodipine, digoxin, insulin, sulfonylureas, sedatives and antidepressants, all of which may influence blood pressure or heart function.

Nebivolol should not be used in pregnancy unless clearly necessary. It passes into breast milk, and mothers receiving it should not breastfeed. On driving, studies have shown no effect on psychomotor function, though occasional dizziness or fatigue means you should wait until you feel steady. Report suspected side effects via the Yellow Card scheme.