Nebivolol Titration Schedule for Hypertension
The recommended titration schedule for nebivolol starts with an initial dose of 5 mg once daily, with dose adjustments every 2 weeks as needed up to a maximum of 40 mg daily. 1
Initial Dosing
- Start with 5 mg once daily (with or without food)
- Can be used as monotherapy or in combination with other antihypertensive agents
- Special populations requiring lower initial doses:
- Severe renal impairment (CrCl <30 mL/min): Start with 2.5 mg once daily
- Moderate hepatic impairment: Start with 2.5 mg once daily
Titration Protocol
- Begin with 5 mg once daily
- Assess blood pressure response after 2 weeks
- If target blood pressure not achieved, increase dose at 2-week intervals
- Maximum dose: 40 mg daily
Monitoring During Titration
- Blood pressure response
- Heart rate (nebivolol causes mild reduction in heart rate)
- Signs/symptoms of adverse effects
- No dose adjustments needed for:
- Elderly patients
- CYP2D6 poor metabolizers
Special Considerations
- Nebivolol is a highly selective β1-adrenergic receptor blocker with nitric oxide-mediated vasodilatory effects 2
- Unlike other beta blockers, nebivolol has a more favorable hemodynamic profile and does not significantly affect glucose or plasma lipid metabolism 2
- Response rates to nebivolol therapy range from 58% to 81% after 4-52 weeks of treatment 2
- Avoid abrupt discontinuation to prevent rebound tachycardia 3
Contraindications
- Severe hepatic impairment (not recommended)
- Severe bradycardia
- High-grade AV block (without pacemaker)
- Cardiogenic shock
- Decompensated heart failure
Adverse Effects
- Most common: headache, fatigue, paresthesias, and dizziness
- Generally infrequent, transient, and mild to moderate in severity 2
- Studies have reported no signs of orthostatic hypotension with nebivolol 2
- Compared to other antihypertensives, nebivolol has fewer reports of impotence or decreased libido 2
Nebivolol has demonstrated similar or superior antihypertensive efficacy compared to other agents like atenolol, metoprolol, lisinopril, and nifedipine 2, 4, 5, 6. Its once-daily dosing regimen and favorable side effect profile make it a good option for hypertension management.