From the Research
The maximum dose of Bystolic (nebivolol) for dialysis patients is typically 5 mg once daily, with a starting dose of 2.5 mg once daily and careful titration up to the maximum dose if needed and tolerated. This recommendation is based on the most recent and highest quality study available, which evaluated the effects of nebivolol on postdialysis and ambulatory blood pressure in patients with intradialytic hypertension 1. The study found that nebivolol reduced postdialysis and 24-h blood pressure in patients with intradialytic hypertension, with a weekly administration having a greater effect.
Key Considerations
- The dose of Bystolic should be adjusted gradually, allowing at least 2 weeks between dose increases to assess the patient's response and tolerance to the medication.
- Close monitoring for hypotension, bradycardia, and other side effects is essential when using Bystolic in dialysis patients.
- Nebivolol is partially eliminated by the kidneys, and patients with severe renal impairment, including those on dialysis, have decreased clearance of the medication, leading to increased plasma concentrations and potentially more adverse effects at standard doses.
Supporting Evidence
- A study published in the Journal of Hypertension found that nebivolol and irbesartan reduced postdialysis and 24-h blood pressure in patients with intradialytic hypertension, with nebivolol being numerically slightly more potent than irbesartan 1.
- Another study published in the Journal of Clinical Hypertension found that nebivolol increased blood nitric oxide levels in hypertensive kidney transplant recipients, which may have beneficial effects on blood pressure and renal function 2.
- A study published in the American Journal of Physiology found that nebivolol avoided the impairment in microvascular function during exercise seen with metoprolol in hypertensive patients 3.