From the Guidelines
When converting from Bystolic (nebivolol) to bisoprolol, a general guideline is that 5 mg of nebivolol is approximately equivalent to 5 mg of bisoprolol, as both are beta-blockers with different pharmacological properties, and the conversion should be done gradually, typically starting with half the equivalent dose of bisoprolol and then titrating up as needed based on blood pressure and heart rate response 1. The conversion process should prioritize monitoring for changes in blood pressure, heart rate, and any side effects during the transition.
- Key considerations include:
- Starting with half the equivalent dose of bisoprolol and titrating up as needed
- Monitoring blood pressure and heart rate response
- Adjusting the dosing based on individual patient response
- Supervising the conversion by a healthcare provider
- Avoiding abrupt discontinuation of either medication to prevent rebound hypertension or worsening of underlying cardiac conditions. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults, bisoprolol is preferred in patients with HFrEF, and the usual dose range is 2.5-10 mg once daily 1. In terms of specific dosing, the guideline recommends starting with a low dose and titrating up as needed, with a typical starting dose of 2.5 mg once daily and a target dose of 10 mg once daily 1. It's also important to note that nebivolol has additional vasodilatory effects through nitric oxide release, while bisoprolol is more cardioselective at lower doses, which may impact the conversion process 1.
From the Research
Dose Conversion from Bystolic to Bisoprolol
- The provided studies do not directly address the dose conversion from Bystolic (nebivolol) to bisoprolol 2, 3, 4, 5, 6.
- However, the studies compare the efficacy and safety of nebivolol and bisoprolol in treating hypertension and heart failure.
- A study published in 2003 found that 5 mg of nebivolol and 5 mg of bisoprolol had similar effects on blood pressure reduction 2.
- Another study published in 2019 discussed the challenges of switching between beta-blockers, including the need for dose adjustments, but did not provide specific guidance on converting from nebivolol to bisoprolol 3.
- A 2009 review of nebivolol's clinical pharmacology and efficacy noted that it is as effective as other beta-blockers, including bisoprolol, in lowering blood pressure, but did not address dose conversion 4.
- A 2022 review of highly selective beta-blockers, including bisoprolol and nebivolol, discussed their therapeutic properties but did not provide information on dose conversion 5.
- A 2009 study comparing the effects of nebivolol and bisoprolol on endothelial function found that both drugs had similar effects on blood pressure, but nebivolol improved endothelial function more significantly 6.