Bystolic is a cardioselective beta blocker (active ingredient: nebivolol) indicated for the treatment of hypertension in adults. By selectively blocking beta‑1 receptors in the heart and promoting nitric oxide–mediated vasodilation in the blood vessels, it lowers resting and exercise heart rate, reduces myocardial contractility, and decreases peripheral vascular resistance. The result is smoother, more sustained blood pressure control, which helps reduce the risk of stroke, heart attack, and other complications when used alongside diet, exercise, and other prescribed therapies.
Clinicians often choose Bystolic for patients who may benefit from a beta blocker yet are sensitive to the metabolic or respiratory effects of older, nonselective agents. Its beta‑1 selectivity and vasodilatory properties can translate to fewer cold‑extremity complaints and a low incidence of certain metabolic side effects in many patients. While its primary FDA‑approved use is hypertension, beta blockers, including nebivolol, may also be used in clinical practice for rate control in certain arrhythmias or for symptom relief in anxiety‑related tachycardia—always under clinician guidance.
Bystolic is not a first‑line therapy for all patients; treatment is individualized based on coexisting conditions, age, and risk profile. It may be especially helpful in people with elevated heart rate as a component of their hypertension or in those who need a beta blocker added to a regimen that may include ACE inhibitors/ARBs, calcium channel blockers, or thiazide diuretics.
The usual starting dose for adults with hypertension is Bystolic 5 mg taken once daily, with or without food, at roughly the same time each day. Depending on blood pressure response and tolerability, the dose may be titrated at 2‑week intervals to 10 mg, 20 mg, and up to a maximum of 40 mg once daily. Because nebivolol has a long half‑life, once‑daily dosing provides round‑the‑clock coverage.
Special populations: In severe renal impairment (creatinine clearance <30 mL/min) or moderate hepatic impairment, clinicians often start at 2.5 mg once daily and titrate cautiously. Severe hepatic impairment is generally a contraindication. Older adults and individuals known to be CYP2D6 poor metabolizers may require lower starting doses and slower titration due to higher drug exposure.
Do not abruptly stop Bystolic. Sudden discontinuation of a beta blocker can precipitate rebound tachycardia, hypertension, or worsen ischemic symptoms. If discontinuation is necessary, prescribers typically recommend tapering the dose over 1–2 weeks while monitoring heart rate and blood pressure. Take Bystolic consistently; if a dose is missed, follow the guidance below and consult your clinician for personalized instructions.
Respiratory conditions: Although Bystolic is beta‑1 selective, high doses or individual sensitivity can diminish selectivity. People with asthma or severe chronic obstructive pulmonary disease (COPD) may experience bronchospasm. Prescribers weigh risks and benefits and may choose alternative agents or use the lowest effective dose with close monitoring.
Metabolic effects and masking symptoms: Beta blockers can mask signs of hypoglycemia (like rapid heartbeat) in people with diabetes who use insulin or sulfonylureas. They can also blunt symptoms of hyperthyroidism. Regular glucose monitoring, awareness of alternative hypoglycemia symptoms (sweating, tremor, confusion), and clinician oversight are essential.
Cardiovascular cautions: Use Bystolic cautiously in patients with peripheral vascular disease, Raynaud’s phenomenon, conduction abnormalities, or resting bradycardia. Inform your clinician if you experience new or worsening dizziness, fainting, shortness of breath, or swelling of the ankles/feet. Prior to surgery, anesthesia teams should know you are on a beta blocker; abrupt withdrawal is discouraged and perioperative plans should be individualized.
Other considerations: Depression, sleep disturbances, and sexual dysfunction can occur with beta blockers; discuss any mood or libido changes. During pregnancy and lactation, risk–benefit must be assessed; beta blockers may be associated with fetal or neonatal bradycardia and hypoglycemia. Do not share Bystolic with others, and keep all follow‑up appointments for blood pressure and heart rate checks.
Do not use Bystolic if you have: severe bradycardia; greater‑than‑first‑degree heart block (unless a functioning pacemaker is present); cardiogenic shock; decompensated heart failure requiring inotropic support; severe hepatic impairment; or known hypersensitivity to nebivolol or any formulation component. These conditions increase the risk of dangerous drops in heart rate or blood pressure, conduction disturbances, or drug accumulation.
Relative contraindications/cautions include asthma, severe COPD, symptomatic peripheral arterial disease, and untreated pheochromocytoma (if a beta blocker is considered, alpha‑blockade should be established first). Always review your full medical history with a licensed clinician before starting Bystolic (nebivolol) or any blood pressure medication.
Common side effects include headache, dizziness, fatigue, nausea, and bradycardia (slow heartbeat). Some individuals may notice cold hands/feet or mild gastrointestinal changes such as constipation or diarrhea. These effects are often dose‑related and may improve as your body adjusts or with dose optimization guided by your clinician.
Less common reactions can include sleep disturbances, vivid dreams, depression, shortness of breath, or rash. Sexual side effects, such as decreased libido or erectile difficulties, can occur with beta blockers. Nebivolol’s vasodilatory properties may reduce the incidence of certain side effects compared with older agents, but individual responses vary.
Seek medical attention urgently for severe dizziness or fainting, chest pain, swelling of the face/lips/tongue (possible allergy), new or worsening shortness of breath or wheezing, extremely slow heart rate, or signs of heart failure (rapid weight gain, edema, worsening fatigue). Report any bothersome or persistent effects to your healthcare provider; dose changes or alternative therapies may be considered.
CYP2D6 interactions: Nebivolol is metabolized primarily by CYP2D6. Strong inhibitors (for example, paroxetine, fluoxetine, bupropion, quinidine, propafenone) can raise nebivolol levels and increase the risk of bradycardia or hypotension. Dose adjustments or closer monitoring may be needed. Conversely, CYP2D6 inducers are less common but could lower exposure.
Additive effects on heart rate and AV conduction: Combining Bystolic with non‑dihydropyridine calcium channel blockers (verapamil, diltiazem), certain antiarrhythmics (amiodarone, sotalol, class I agents), digoxin, or clonidine can increase the risk of bradycardia, AV block, or hypotension. If clonidine is used concurrently, clinicians typically advise to taper the beta blocker first before clonidine to minimize rebound hypertension.
Other considerations: NSAIDs (like ibuprofen, naproxen) may blunt antihypertensive effects with chronic use; prefer the lowest effective dose for the shortest duration and monitor blood pressure. Alcohol and sedatives can enhance dizziness. Insulin and oral hypoglycemics may have enhanced hypoglycemic effects while warning symptoms are masked. Anesthetics and some inhaled agents can increase hypotension risk. Always provide your clinician and pharmacist a complete list of prescriptions, over‑the‑counter medicines, vitamins, and herbal supplements (e.g., St. John’s wort) before starting Bystolic.
If you miss a dose of Bystolic, take it as soon as you remember on the same day. If it is near the time of your next dose, skip the missed dose and resume your regular schedule. Do not double up to make up for a missed dose, as this may increase the risk of excessively slow heart rate or low blood pressure. If you miss multiple doses, check your blood pressure and contact your clinician for guidance on how to restart safely.
Nebivolol overdose can cause profound bradycardia, hypotension, heart block, heart failure, bronchospasm, and hypoglycemia. If an overdose is suspected, call emergency services or poison control immediately. Do not wait for symptoms to appear. Bring the medication bottle with you if possible.
Management in medical settings may include atropine for bradycardia, IV fluids and vasopressors for hypotension, glucagon as a beta‑blocker antidote, high‑dose insulin therapy in select cases, bronchodilators for bronchospasm, temporary pacing for severe conduction block, and activated charcoal if presentation is early. Supportive monitoring of glucose, electrolytes, and cardiac rhythm is essential.
Store Bystolic tablets at controlled room temperature (generally 20–25°C/68–77°F) in a dry place, away from excessive heat, moisture, and direct light. Keep tablets in their original, tightly closed container with the label intact. Do not store in bathrooms. Keep out of reach of children and pets. Do not use after the expiration date. If your pharmacy provides unit‑dose packaging for convenience, maintain the blister integrity until use and avoid transferring tablets to unlabeled containers.
In the United States, Bystolic (nebivolol) is a prescription‑only medication. Federal and state laws require that a licensed clinician evaluate each patient to determine whether Bystolic is appropriate, set a safe dose, and provide ongoing monitoring. Any pathway to obtain Bystolic must comply with these rules—there are no lawful shortcuts that bypass clinical review.
HealthSouth MountainView offers a legal, structured solution for people who do not already have a prescription in hand. Rather than “skipping” the prescription step, the service integrates it: you complete a secure medical questionnaire and, when appropriate, a synchronous telehealth visit with a licensed U.S. clinician. If Bystolic is clinically indicated, a prescription is issued and routed to a partner pharmacy for fulfillment and delivery.
This compliant telehealth model preserves patient safety and convenience—no waiting rooms, transparent pricing, pharmacist counseling, and shipment tracking—while upholding all regulatory requirements. Always avoid sources that claim to sell Bystolic without any medical review; using such channels may be unsafe, counterfeit‑prone, and unlawful. For ongoing therapy, keep your blood pressure records handy, attend follow‑ups, and report side effects so your care team can optimize treatment.
Bystolic is the brand name for nebivolol, a cardioselective beta-blocker used primarily to treat high blood pressure (hypertension). It lowers heart rate, reduces the force of contraction, and promotes nitric oxide–mediated vasodilation, helping relax blood vessels.
Nebivolol blocks beta-1 receptors in the heart to slow the heart rate and reduce cardiac output. Uniquely, it also enhances nitric oxide release in the blood vessel lining, causing gentle vasodilation that further lowers blood pressure.
In the United States, Bystolic is approved for hypertension in adults. Clinicians may use it off-label for issues like inappropriate sinus tachycardia; in some regions it’s used in stable heart failure, though other beta-blockers have stronger heart failure approvals.
Avoid Bystolic if you have severe bradycardia, second- or third-degree heart block (without a pacemaker), sick sinus syndrome (without a pacemaker), cardiogenic shock, decompensated heart failure, or severe liver impairment. Use caution with asthma/COPD, peripheral vascular disease, and in people with very low resting heart rates.
Most adults start at 5 mg once daily, with dose increases every 1–2 weeks as needed to a usual range of 5–20 mg and a maximum of 40 mg daily. Always take it at the same time each day; your clinician will tailor dosing to your blood pressure and heart rate.
You can take Bystolic with or without food. If you miss a dose, take it when you remember unless it’s close to the next dose—never double up; just resume your usual schedule.
Common side effects include headache, dizziness, fatigue, nausea, slow heart rate, and sometimes trouble sleeping or cold hands/feet. Most are mild and improve as your body adjusts.
Seek care for fainting, severe dizziness, wheezing or shortness of breath, swelling of face/lips/tongue, very slow heart rate, new or worsening chest pain, or signs of heart failure like rapid weight gain or leg swelling.
Yes. It lowers resting and exercise heart rates, which can reduce peak exercise capacity for some. Many people still exercise safely; monitor how you feel and discuss target heart rate and activity plans with your clinician.
Weight changes are usually minimal. Fatigue can occur early in treatment or after dose increases; it often improves over time. If persistent or severe, talk to your prescriber about dose adjustments or alternatives.
Any beta-blocker can contribute to sexual side effects, but nebivolol’s nitric oxide–mediated vasodilation may make erectile dysfunction less likely than with some older beta-blockers. If you notice changes in sexual function, let your clinician know—adjustments can help.
CYP2D6 inhibitors (such as paroxetine, fluoxetine, quinidine, ritonavir) can raise nebivolol levels. Combining with other heart rate–lowering drugs (diltiazem, verapamil, digoxin, amiodarone) increases bradycardia risk. NSAIDs may blunt blood pressure control, and alcohol or PDE5 inhibitors can amplify dizziness. If you take clonidine, do not stop it before tapering the beta-blocker—ask your clinician for a safe plan.
Nebivolol is beta-1 selective, making bronchospasm less likely than with nonselective beta-blockers, but the risk is not zero. If you have reactive airway disease, use caution, start low, and monitor breathing; have your rescue inhaler available.
Yes, but beta-blockers can mask signs of hypoglycemia (like tremor and palpitations), though sweating usually persists. Nebivolol tends to be metabolically neutral; still, check glucose more often when starting or changing dose.
You can see effects within hours, with full effect at a given dose typically in 1–2 weeks. Check home blood pressure and heart rate at consistent times, keep a log, and share it during follow-up visits.
Avoid abrupt discontinuation. Stopping suddenly can cause rebound high blood pressure, increased heart rate, and angina. Your clinician will taper the dose gradually if it’s time to stop.
Beta-blockers can affect fetal growth and may cause neonatal bradycardia; labetalol is often preferred during pregnancy. Nebivolol can pass into breast milk—discuss risks and alternatives with your clinician.
Yes, generic nebivolol is available and usually lowers cost compared with the brand. Prices vary by pharmacy and insurance; discount programs and mail-order options can help.
For severe kidney impairment (CrCl <30 mL/min), a lower starting dose (for example, 2.5 mg daily) is often used. Nebivolol is contraindicated in severe liver impairment; use caution and possible dose reduction in moderate impairment.
It is highly beta-1 selective and promotes nitric oxide–mediated vasodilation, which may improve tolerability for some patients (for example, fewer cold extremities or less sexual dysfunction) while providing effective once-daily blood pressure control.
Both lower blood pressure and heart rate effectively. Bystolic adds nitric oxide–mediated vasodilation and may have a lower risk of sexual side effects, while metoprolol has robust outcome data in post–heart attack care and heart failure (metoprolol succinate), and is often less expensive.
Atenolol is older and inexpensive but has less consistent outcome data in hypertension compared with some newer agents. Bystolic tends to provide smoother 24-hour control with potential tolerability advantages; the best choice depends on your health profile and cost considerations.
Carvedilol is nonselective with alpha-1 blockade and is a cornerstone therapy for heart failure with reduced ejection fraction. It may be metabolically favorable in diabetes. Bystolic is excellent for hypertension but is not a first-line beta-blocker for heart failure in U.S. practice.
Both are highly beta-1 selective and generally well tolerated. Bisoprolol has strong evidence in heart failure; nebivolol offers nitric oxide–mediated vasodilation and may be associated with fewer sexual side effects for some individuals.
Propranolol is nonselective and commonly used for performance anxiety and migraine prevention, but it is not preferred for routine hypertension. Bystolic is designed for daily blood pressure control and usually causes fewer central nervous system side effects.
Labetalol blocks alpha-1 and beta receptors and is widely used for hypertension in pregnancy and as an IV option for acute severe hypertension. Bystolic is an oral, once-daily option for chronic blood pressure control outside of pregnancy.
Nadolol is nonselective with a long half-life, allowing once-daily dosing, but it is renally cleared and requires dose adjustments in kidney disease. Bystolic is cardioselective, metabolized primarily by the liver (CYP2D6), and often better tolerated in people with airway disease.
No. Sotalol is both a nonselective beta-blocker and a class III antiarrhythmic that prolongs the QT interval; it is used for arrhythmias under close monitoring and is not a routine hypertension treatment. Bystolic is for blood pressure control and heart rate reduction.
Acebutolol has intrinsic sympathomimetic activity (ISA), partially stimulating beta receptors while blocking them, which can cause less resting bradycardia but may blunt protective effects after a heart attack. Bystolic does not have ISA and provides steady heart-rate control.
Esmolol is an IV, ultra–short-acting beta-blocker used in hospitals for rapid heart-rate control. Bystolic is an oral, long-acting once-daily medication for chronic blood pressure management.
Timolol is a nonselective beta-blocker used mostly as ophthalmic drops for glaucoma, though systemic absorption can still slow heart rate. Bystolic is taken orally for systemic blood pressure control with cardioselective action.
Betaxolol is beta-1 selective and often used as an eye drop for glaucoma; oral forms exist but are less commonly used for hypertension. Bystolic has broader use for systemic hypertension and unique nitric oxide–mediated vasodilation.
Generic nebivolol has lowered costs, but it may still be pricier than widely available generics like metoprolol or atenolol. Some patients value Bystolic’s once-daily dosing and potential tolerability benefits; the “best” option balances blood pressure goals, side effects, comorbidities, and cost—work with your clinician to choose.
