nebivolol: clinical use

Prescribing considerations

• Confirm that chronic heart failure is stable before initiation; initiation and adjustment require experienced supervision and clinical monitoring.
• Avoid abrupt withdrawal, especially in ischaemic heart disease or chronic heart failure.
• Use caution with first-degree heart block, peripheral vascular disease, Prinzmetal angina, chronic obstructive pulmonary disease, diabetes, hyperthyroidism, psoriasis and significant allergy history.
• Evidence in children and adolescents is insufficient for the selected product.
• Review renal function and product restrictions relevant to the indication; hepatic impairment is a contraindication.

Contraindications and cautions

• Hypersensitivity to nebivolol or an excipient
• Liver insufficiency or impaired liver function
• Acute or decompensated heart failure, cardiogenic shock, or need for intravenous inotropic support
• Sick sinus syndrome, sinoatrial block, or higher-degree atrioventricular block without a pacemaker
• Clinically significant bradycardia or hypotension before treatment
• History of bronchospasm or bronchial asthma
• Untreated phaeochromocytoma, metabolic acidosis or severe peripheral circulatory disturbance

Monitoring

• Blood pressure, resting pulse and symptoms of bradycardia or hypotension
• Cardiac conduction and signs of worsening heart failure where clinically relevant
• Blood glucose and recognition of hypoglycaemia in people with diabetes
• Respiratory symptoms in susceptible patients
• Fetal growth and uteroplacental blood flow if treatment is necessary during pregnancy; observe the newborn for beta-blockade effects

Clinical pharmacology

Nebivolol is a racemic, selective beta-1-adrenoceptor antagonist with nitric-oxide-mediated vasodilating activity. It is extensively metabolised through CYP2D6 to active metabolites; genetic metabolic differences and CYP2D6 inhibitors can substantially alter exposure.

Formulation and product differences

• The selected product is a round, uncoated, cross-scored tablet that can be divided into equal halves.
• It contains lactose monohydrate and is described as essentially sodium-free.
• Tablet appearance, score pattern, divisibility and excipients may differ between manufacturers; check the specific product information.

Tablet

Route: Oral

Strengths: 5 mg