What is the typical dosing for Nebivolol (beta blocker) in treating hypertension?

Nebivolol Dosing for Hypertension

The recommended starting dose of nebivolol for hypertension is 5 mg once daily, with titration up to 40 mg daily if needed for blood pressure control, with dose adjustments made at 2-week intervals. 1

Standard Dosing Protocol

• Initial dose: 5 mg once daily (with or without food)
• Titration: May increase dose at 2-week intervals
• Maximum dose: 40 mg once daily
• Administration: Can be taken as monotherapy or in combination with other antihypertensive agents

Special Population Dosing Adjustments

Renal Impairment

• Severe renal impairment (CrCl <30 mL/min): Start with 2.5 mg once daily and titrate slowly as needed
• Dialysis patients: Not studied, use with caution

Hepatic Impairment

• Moderate hepatic impairment: Start with 2.5 mg once daily and titrate slowly
• Severe hepatic impairment: Not recommended due to lack of studies

Elderly Patients

• No dose adjustment necessary for elderly patients 1
• However, clinical practice often suggests starting at lower doses (2.5 mg) in very elderly or frail patients

CYP2D6 Polymorphism

• No dose adjustments necessary for CYP2D6 poor metabolizers
• Clinical effects and safety profiles are similar between poor and extensive metabolizers 1

Efficacy and Clinical Considerations

Nebivolol is a highly selective beta-1 receptor antagonist with nitric oxide-mediated vasodilatory effects 2. This unique mechanism provides several advantages:

• Effectively reduces blood pressure comparable to other beta-blockers (atenolol, metoprolol) and other antihypertensive classes 2
• Response rates range from 58-81% after 4-52 weeks of treatment 2
• Once-daily dosing provides 24-hour blood pressure control, including early morning blood pressure surges 2
• Clinical trials have shown that the 5 mg dose is optimal for most patients, with minimal additional benefit at higher doses 3

Safety Profile

Nebivolol has a favorable side effect profile compared to other beta-blockers:

• Most common adverse events are transient headache, dizziness, fatigue, and paresthesias 2
• Lower incidence of erectile dysfunction and decreased libido compared to other beta-blockers 2
• Does not significantly affect glucose or plasma lipid metabolism 2
• No significant orthostatic hypotension reported in several studies 2

Monitoring Parameters

• Blood pressure response (goal: reduction by at least 20/10 mmHg or to target <140/90 mmHg) 4
• Heart rate (monitor for excessive bradycardia)
• Signs of orthostatic hypotension, especially when initiating therapy
• Achievement of target blood pressure within 3 months 4

Clinical Pearls

• Nebivolol should not be abruptly discontinued due to risk of rebound hypertension 4
• Consider combination therapy with thiazide diuretics for additive effects if monotherapy is insufficient 2
• Nebivolol has protective effects on left ventricular function, making it a good choice for patients with hypertension and heart failure concerns 2
• Unlike many other beta-blockers, nebivolol may be better tolerated in patients with mild reactive airway disease due to its high beta-1 selectivity

Nebivolol represents an effective option for treating hypertension with a favorable side effect profile compared to traditional beta-blockers, particularly regarding metabolic parameters and sexual function.