From the FDA Drug Label
The dose of nebivolol tablets must be individualized to the needs of the patient. For patients requiring further reduction in blood pressure, the dose can be increased at 2-week intervals up to 40 mg The next dose up from Bystolic 20mg would be 40mg, as the dose can be increased up to 40 mg for patients requiring further reduction in blood pressure 1.
- The dose increase should be done at 2-week intervals.
- Individualization of the dose is necessary, and the decision to increase the dose should be based on the patient's needs.
From the Research
Bystolic (nebivolol) 20mg is already the maximum FDA-approved dose for this medication, and there is no standard next dose up from Bystolic 20mg. If you're taking the maximum dose and not achieving adequate blood pressure control, your healthcare provider would typically consider adding a different class of antihypertensive medication rather than increasing the Bystolic dose further. This approach is preferred because exceeding the maximum recommended dose typically provides minimal additional benefit while potentially increasing the risk of side effects such as bradycardia (slow heart rate), fatigue, and dizziness. Nebivolol works by selectively blocking beta-1 receptors in the heart, reducing heart rate and cardiac output, while also promoting nitric oxide release which helps dilate blood vessels. Some key points to consider when managing hypertension with Bystolic include:
- The importance of combination therapy: Studies such as 2 have shown that combining nebivolol with other antihypertensive agents like valsartan can be effective in reducing blood pressure.
- The role of ambulatory blood pressure monitoring: As seen in 2, this method can provide valuable insights into the effects of different treatment regimens on blood pressure over a 24-hour period.
- The potential benefits of nebivolol: Research like 3 has highlighted the association between nebivolol use and better outcomes in patients with heart failure. If your blood pressure remains uncontrolled on maximum Bystolic, discuss with your doctor about combination therapy options, which might include adding medications like ACE inhibitors, ARBs, calcium channel blockers, or diuretics for more comprehensive blood pressure management. It's also worth noting that the choice of additional medication should be based on individual patient factors, such as comorbidities and potential side effects, as well as the results of studies like 4, which have investigated the time-dependent effects of different treatment combinations on blood pressure and vascular reactivity.