What is the recommended dosage of nebivolol (beta blocker) for hypertension?

Nebivolol Dosing for Hypertension

For most patients with hypertension, start nebivolol at 5 mg once daily and titrate up to 40 mg daily if needed for blood pressure control, with dose increases at 2-week intervals. 1

Standard Dosing Regimen

• Initial dose: 5 mg once daily (with or without food), as monotherapy or in combination with other antihypertensive agents 1
• Titration schedule: Increase dose at 2-week intervals if further blood pressure reduction is required 1
• Maximum dose: 40 mg once daily 1
• More frequent dosing intervals are unlikely to provide additional benefit 1

Dose Adjustments for Special Populations

Severe Renal Impairment

• Initial dose: 2.5 mg once daily for patients with creatinine clearance <30 mL/min 1
• Titrate slowly as needed 1
• Nebivolol has not been studied in dialysis patients 1

Moderate Hepatic Impairment

• Initial dose: 2.5 mg once daily 1
• Titrate slowly as needed 1
• Not recommended in severe hepatic impairment due to lack of safety data 1

Elderly Patients

• No dose adjustment necessary 1

CYP2D6 Poor Metabolizers

• No dose adjustment required, as clinical effects and safety profiles are similar to extensive metabolizers 1

Clinical Efficacy Evidence

• The 5 mg once daily dose reduces resting diastolic blood pressure as effectively as standard doses of atenolol, metoprolol, lisinopril, and nifedipine 2
• Response rates (achieving diastolic BP ≤90 mmHg or ≥10 mmHg reduction) range from 58-81% after 4-52 weeks of treatment 2
• In long-term studies, 78% of patients responded to nebivolol monotherapy, with 72% of patients maintained on monotherapy alone 3

Combination Therapy

• Nebivolol has additive antihypertensive effects when combined with hydrochlorothiazide 2, 4
• In long-term studies, 24% of patients required addition of a diuretic, with 65% of these combination patients achieving response 3

Dosing Equivalence to Other Beta-Blockers

• Nebivolol 5 mg daily is equivalent to metoprolol 50 mg daily for hypertension management 5
• Maximum dose of nebivolol (10 mg) for heart failure is equivalent to metoprolol succinate 200 mg 5

Safety and Tolerability

• Adverse events are infrequent, transient, and mild to moderate 2
• Most common adverse effects include headache, fatigue, paresthesias, and dizziness 2
• No orthostatic hypotension reported in clinical studies 2
• Overall adverse event incidence decreases over time with continued therapy 3

Important Clinical Considerations

• Beta-blockers are not first-line agents for hypertension unless the patient has ischemic heart disease or heart failure 6
• Nebivolol's unique nitric oxide-mediated vasodilatory properties distinguish it from other beta-blockers 2, 7
• The drug does not significantly influence glucose or plasma lipid metabolism 2
• Avoid abrupt discontinuation, which can lead to rebound hypertension or worsening cardiac symptoms 5