Top 300 Pharmacy Drug Cards

NEBIVOLOL: Bystolic

Class: β-Adrenergic Blocker, Cardioselective, B1 Selective

Dosage Forms. Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg

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Common FDA Label Indication, Dosing, and Titration.

1. Hypertension: 5 mg po daily; may titrate to max 40 mg po daily

Off-Label Uses.

1. Congestive heart failure: 1.25 mg po daily; may titrate to 10 mg po daily

2. Migraine prophylaxis: 5 mg po daily

MOA. Nebivolol is a long-acting cardioselective β1-adrenoceptor antagonist without intrinsic sympathomimetic activities. The mechanism of action of the antihypertensive response of nebivolol is not fully understood. Possible mechanisms include decreased heart rate, decreased myocardial contractility and vasodilation, and decreased peripheral vascular resistance.

Drug Characteristics: Nebivolol

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Medication Safety Issues: Nebivolol

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Drug Interactions: Nebivolol

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Adverse Reactions: Nebivolol

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Efficacy Monitoring Parameters. Decreased BP.

Toxicity Monitoring Parameters. Decreased heart rate, bronchospasm, increased blood glucose levels in diabetic patients.

Key Patient Counseling Points. Report signs/symptoms of hypotension, worsening CHF, or bronchospastic disease. Do not drink alcohol. May cause dizziness. Avoid activities that could be dangerous if not alert. Diabetic patients should carefully monitor blood sugar levels as beta-blockers may mask symptoms of hypoglycemia. Do not discontinue drug abruptly, as this may cause rebound angina or, in some cases, myocardial infarction.

Clinical Pearls. Safety and efficacy not established in children. Patients should avoid concomitant use of calcium channel blockers, as concomitant use may significantly affect heart rate or rhythm.