What is the dosing for Bystolic (Nebivolol)?

From the Guidelines

Bystolic (nebivolol) is typically started at a dose of 5 mg once daily for hypertension treatment, with a maximum recommended dose of 40 mg daily, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

Key Considerations for Bystolic Dosing

• The dose can be adjusted based on blood pressure response, usually after 2 weeks.
• For patients with severe renal impairment or moderate liver impairment, the starting dose should be lower at 2.5 mg daily.
• Elderly patients may also start at 2.5 mg.
• Bystolic should be taken at the same time each day to maintain consistent blood levels and can be taken with or without food.

Special Properties of Nebivolol

• Unlike traditional beta-blockers, nebivolol has vasodilatory properties through nitric oxide release, which may result in fewer side effects like fatigue and sexual dysfunction.

Discontinuation and Side Effects

• Patients should not stop taking Bystolic suddenly as this can worsen heart conditions; dosage should be gradually reduced over 1-2 weeks when discontinuing.
• Common side effects include headache, fatigue, and dizziness, which often improve with continued use.

Evidence-Based Recommendations

• The recommended dosing is based on the most recent and highest quality studies, including the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
• The guideline provides evidence-based recommendations for the management of high blood pressure in adults, including the use of beta blockers like nebivolol.

From the FDA Drug Label

1. 1 Hypertension The dose of nebivolol tablets must be individualized to the needs of the patient. For most patients, the recommended starting dose is 5 mg once daily, with or without food, as monotherapy or in combination with other agents. For patients requiring further reduction in blood pressure, the dose can be increased at 2-week intervals up to 40 mg Renal Impairment In patients with severe renal impairment (ClCr less than 30 mL/min) the recommended initial dose is 2.5 mg once daily; titrate up slowly if needed. Hepatic Impairment In patients with moderate hepatic impairment, the recommended initial dose is 2.5 mg once daily; titrate up slowly if needed.

The recommended starting dose of Bystolic (nebivolol) is 5 mg once daily. The dose can be increased up to 40 mg at 2-week intervals if needed. For patients with severe renal impairment, the recommended initial dose is 2.5 mg once daily, and for patients with moderate hepatic impairment, the recommended initial dose is also 2.5 mg once daily 2.

• Dose adjustment is not necessary for geriatric patients or CYP2D6 poor metabolizers.
• A more frequent dosing regimen is unlikely to be beneficial.

From the Research

Bystolic Dosing

• The recommended dosage of nebivolol, also known as Bystolic, is 5 mg once daily 3, 4.
• This dosage has been shown to be effective in reducing resting diastolic blood pressure and is well tolerated in patients with hypertension 3.
• No significant further decreases in blood pressure were shown with higher doses, and the average dose in clinical trials for patients with heart failure was 5-10 mg daily 4.
• Dosage adjustments are recommended in elderly patients and patients with severe renal impairment 4.

Efficacy and Safety

• Nebivolol has been shown to be at least as effective at lowering blood pressure as other antihypertensive drugs, including other beta-blockers 3, 5, 4.
• The most frequent adverse events reported in nebivolol clinical trials were transient headache, dizziness, and tiredness 5, 4.
• Nebivolol has a favorable side-effect profile compared to other beta-blockers, with fewer reports of sexual dysfunction, fatigue, depression, and metabolic abnormalities 5.

Clinical Use

• Nebivolol may be useful in the treatment of uncomplicated mild-to-moderate essential hypertension and in patients with heart failure 4, 6.
• According to international guidelines, beta-blockers, including nebivolol, maintain a central role in the management of hypertension, particularly in patients with specific indications such as heart failure, angina, or postacute myocardial infarction 6.