From the Research
The recommended protocol for transitioning from Carvedilol (Coreg) to Nebivolol (Bystolic) involves a gradual taper and overlap approach, as outlined in the most recent and highest quality study available 1. This approach is necessary to minimize the risk of rebound hypertension or tachycardia, and to ensure continuous beta-receptor blockade while accommodating the different pharmacological profiles of these medications.
- The first step is to reduce the Carvedilol dose by 50% while starting Nebivolol at 2.5 mg once daily.
- After 3-7 days, if blood pressure and heart rate remain stable, discontinue Carvedilol completely while continuing or titrating Nebivolol as needed (typical maintenance dose 5-10 mg daily). Some key points to consider during this transition period include:
- Close monitoring of blood pressure and heart rate is essential.
- Patients should be advised to report symptoms like dizziness, fatigue, or significant changes in blood pressure or heart rate.
- Nebivolol is more cardioselective and has vasodilatory properties through nitric oxide pathways, while Carvedilol is a non-selective beta-blocker with alpha-blocking properties.
- Patients with heart failure may require more cautious titration with closer monitoring during the transition process, as noted in earlier studies 2, 3. However, the most recent study 1 provides the most up-to-date guidance on the use of Nebivolol in the management of hypertensive patients, and its recommendations should be prioritized. Overall, a gradual taper and overlap approach is the recommended protocol for transitioning from Carvedilol to Nebivolol, and close monitoring and patient education are essential to ensure a safe and effective transition.