What is the dosage of Nabivelol for hypertension?

Nebivolol Dosage for Hypertension

The recommended dosage of nebivolol for hypertension is 5 mg once daily, which can be titrated up to a maximum of 40 mg daily if needed for blood pressure control. 1

Dosing Guidelines

Nebivolol is a highly selective beta-1 adrenergic receptor blocker with unique vasodilatory properties mediated through nitric oxide modulation. The FDA-approved dosing regimen for hypertension is as follows:

• Initial dose: 5 mg once daily (with or without food)
• Dose titration: Can be increased at 2-week intervals if needed
• Maximum dose: Up to 40 mg daily
• Frequency: Once daily dosing is sufficient; more frequent dosing provides no additional benefit 1

Special Populations

Renal Impairment

• Severe renal impairment (CrCl <30 mL/min): Start with 2.5 mg once daily and titrate slowly if needed
• Dialysis patients: Not studied, use with caution 1

Hepatic Impairment

• Moderate hepatic impairment: Start with 2.5 mg once daily and titrate slowly if needed
• Severe hepatic impairment: Not recommended 1

Elderly Patients

• No dose adjustment necessary for elderly patients 1

CYP2D6 Poor Metabolizers

• No dose adjustments necessary; clinical effects and safety profiles are similar to extensive metabolizers 1

Efficacy and Comparison to Other Antihypertensives

Nebivolol effectively reduces blood pressure, with its antihypertensive effect becoming apparent within two weeks of treatment and maintaining efficacy throughout the 24-hour dosing interval 2. Studies have shown that:

• Nebivolol 5 mg daily reduces resting diastolic blood pressure as effectively as standard therapeutic dosages of atenolol, metoprolol, lisinopril, and nifedipine 3
• It is superior to other beta-blockers and diuretics for systolic blood pressure management 4
• For diastolic blood pressure control, nebivolol is more efficient than other beta-blockers, angiotensin receptor blockers, diuretics, and calcium channel blockers 4

Unique Properties and Benefits

Nebivolol has several advantages over traditional beta-blockers:

• Vasodilatory effects: Induces vasodilation through stimulation of the endothelial nitric oxide/L-arginine pathway 5
• Metabolic neutrality: Does not significantly influence glucose or plasma lipid metabolism 2, 3
• Favorable side effect profile: Less likely to cause sexual dysfunction, fatigue, and metabolic effects compared to older beta-blockers 2
• Beneficial in comorbidities: Demonstrated benefits in patients with heart failure 2

Common Side Effects and Precautions

Common adverse effects include:

• Hypotension
• Bradycardia
• Dizziness
• Fatigue 2

Contraindications

Nebivolol is contraindicated in patients with:

• Severe bradycardia
• AV block of second or third degree
• Cardiogenic shock
• Decompensated heart failure
• Sick sinus syndrome (unless a permanent pacemaker is in place) 2

Important Clinical Considerations

• Avoid abrupt cessation of nebivolol as this can lead to rebound hypertension 6
• Nebivolol may be particularly beneficial in patients with diabetes mellitus due to its favorable effect on glycemic control 2
• The drug undergoes extensive hepatic metabolism through the cytochrome P450 2D6 system, so be cautious when co-administering with drugs that affect this enzyme 5

Nebivolol represents a modern beta-blocker option with vasodilatory properties that make it an effective choice for hypertension management while potentially offering advantages over traditional beta-blockers in terms of metabolic effects and tolerability.