What is the use of Nebivolol (Nebivolol)?

From the Guidelines

Nebivolol is a beta-blocker medication primarily used to treat high blood pressure (hypertension) and can also be used for certain heart conditions, with a recommended starting dose of 5 mg once daily, which may be increased to 10-40 mg daily depending on blood pressure response, as stated in the 2018 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 1. The medication works differently from other beta-blockers by also promoting nitric oxide release, which helps dilate blood vessels, providing blood pressure control with fewer side effects than traditional beta-blockers. Some key points to consider when using nebivolol include:

• Common side effects include headache, fatigue, dizziness, and sometimes slow heart rate.
• Nebivolol should be taken at the same time each day, and patients should not stop taking it suddenly without medical supervision as this can worsen heart conditions.
• It's particularly useful for patients who need blood pressure control but cannot tolerate the fatigue or erectile dysfunction sometimes associated with other beta-blockers.
• Patients with asthma, severe heart failure, or certain heart rhythm disorders should use nebivolol cautiously or avoid it altogether. According to the Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors with heart failure (SENIORS), nebivolol significantly decreased all-cause mortality or cardiovascular hospital admissions over a 21-month follow-up in patients ≥70 years of age with a history of HF 1. Additionally, the European guidelines on cardiovascular disease prevention in clinical practice (version 2012) suggest that vasodilating beta-blockers such as carvedilol and nebivolol have less or no dysmetabolic action, as well as a reduced incidence of new-onset diabetes compared with conventional beta-blockers 1.

From the FDA Drug Label

Nebivolol tablets are indicated for the treatment of hypertension, to lower blood pressure [see Clinical Studies (14. 1)]. Nebivolol tablets may be used alone or in combination with other antihypertensive agents [see Drug Interactions (7)]. Nebivolol tablets treat: • High blood pressure (hypertension) Nebivolol tablets can lower blood pressure when used by itself and with other medicines.

The use of Nebivolol is for the treatment of hypertension, to lower blood pressure. It can be used alone or in combination with other antihypertensive agents 2. Nebivolol tablets are a kind of prescription medicine called a “beta-blocker” that treats high blood pressure (hypertension) 2.

From the Research

Use of Nebivolol

• Nebivolol is a lipophilic beta1-blocker used in the management of essential hypertension 3.
• It has nitric oxide-mediated vasodilatory effects and is administered as a racemic mixture of equal proportions of d- and l-enantiomers 3.
• Nebivolol reduces resting diastolic blood pressure as effectively as standard therapeutic dosages of atenolol, metoprolol, lisinopril, and nifedipine 3.

Efficacy and Tolerability

• A meta-analysis showed that nebivolol 5 mg achieved similar or better rates of treatment response and BP normalization than other drug classes and other antihypertensive drugs combined, with similar tolerability to placebo and significantly better tolerability than losartan, CCAs, other beta-blockers, and all antihypertensive drugs combined 4.
• Nebivolol has an additive effect in combination with hydrochlorothiazide and is well tolerated in patients with hypertension 3, 5.
• The overall incidence of adverse events with nebivolol is comparable to that of placebo and decreases over time 6.

Comparison with Other Antihypertensive Agents

• Nebivolol has been compared with other antihypertensive agents, including bisoprolol, and has shown similar antihypertensive efficacy 7.
• A study found that nebivolol monotherapy had decreases in diastolic and systolic BPs of 15.0 and 14.8 mm Hg, respectively, and more than 78% of patients were responders to nebivolol monotherapy 6.
• Nebivolol has also been shown to have favorable metabolic effects, including an improvement in glucose metabolism 5.