From the Guidelines
Nebivolol does not typically cause hyperreactive airways, as it is a cardioselective beta-blocker with vasodilatory properties, which induces nitric oxide-mediated vasodilation 1.
Key Points
- Beta-blockers are only relatively contraindicated in asthma, but not in COPD, and a more selective β1-adrenoceptor antagonist like nebivolol is preferred 1.
- Nebivolol is a cardioselective beta-blocker with vasodilatory properties, which makes it a suitable option for patients with heart failure or hypertension who also have respiratory conditions 1.
- The contraindication to beta-blockers in asthma is based on small case series published in the 1980s and late 1990s with very high initial dosages in young patients with severe asthma 1.
- In clinical practice, starting with low doses of cardioselective beta-blockers combined with close monitoring for signs of airway obstruction may allow the use of nebivolol in patients with heart failure or hypertension who also have asthma or COPD 1.
From the FDA Drug Label
The most common signs and symptoms associated with nebivolol tablets overdosage are bradycardia and hypotension. Other important adverse reactions reported with nebivolol tablets overdose include cardiac failure, dizziness, hypoglycemia, fatigue and vomiting Other adverse reactions associated with β-blocker overdose include bronchospasm and heart block. Bronchospasm: Administer bronchodilator therapy such as a short acting inhaled β2-agonist and/or aminophylline. The following adverse reactions have been identified from spontaneous reports of nebivolol tablets received worldwide and have not been listed elsewhere... bronchospasm
Nebivolol and Hyperreactive Airways:
- Nebivolol can cause bronchospasm, which is a condition characterized by hyperreactive airways.
- The FDA drug label recommends administering bronchodilator therapy for bronchospasm associated with nebivolol overdose 2.
- Spontaneous reports of nebivolol tablets also include bronchospasm as an adverse reaction 2.
From the Research
Nebivolol and Hyperreactive Airways
- The study 3 found that nebivolol did not cause significant changes in airway obstruction in patients with bronchial hyperreactivity due to asthma, COPD, or unknown origin.
- The same study 3 also found that nebivolol did not increase bronchial hyperreactivity in these patients, suggesting that it is as safe as placebo in this regard.
- Another study 4 found that nebivolol had a slight impact on FEV1 in hypertensive patients with mild to moderate COPD, but did not significantly affect day-to-day airway obstruction control.
- A review of nebivolol's effects 5 noted that it is usually well-tolerated by patients with asthma or COPD, suggesting that it may not cause hyperreactive airways in these patients.
- An experimental study 6 found that nebivolol attenuated oxidative stress and inflammation in a guinea pig model of ovalbumin-induced asthma, which may contribute to its favorable respiratory effects.
Mechanisms of Nebivolol's Effects
- Nebivolol's ability to stimulate endothelial nitric oxide synthase and scavenge reactive oxygen species may contribute to its favorable effects on airway reactivity and inflammation 7, 6.
- The drug's selective β1-adrenoceptor blocking properties and nitric oxide-mediated vasodilatory effects may also play a role in its effects on airway reactivity and hyperreactivity 3, 4.