Nebivolol is a cardioselective beta‑blocker primarily indicated for the treatment of hypertension (high blood pressure). By selectively blocking beta‑1 receptors in the heart, it reduces heart rate and myocardial oxygen demand, while its unique ability to enhance nitric oxide bioavailability helps dilate blood vessels. The combined effects can lower blood pressure and support overall cardiovascular function.
In clinical practice, Nebivolol is often chosen for adults who need once‑daily blood pressure control and for patients who have not tolerated older beta blockers due to fatigue, sexual dysfunction, or metabolic side effects. It may be considered in individuals with coexisting conditions such as type 2 diabetes or metabolic syndrome because it is generally metabolically neutral; however, therapy should always be individualized.
Outside the U.S., Nebivolol may have additional labeled uses (such as certain cases of chronic heart failure). In the U.S., use beyond hypertension is off‑label and should be guided by a clinician who can balance benefits, risks, and alternative treatments.
For adult hypertension, a common starting dose of Nebivolol is 5 mg once daily, taken at the same time each day, with or without food. Based on blood pressure response and tolerability, the dose may be titrated at intervals of approximately two weeks. Typical maintenance doses range from 5–20 mg once daily; some patients may require up to 40 mg, though higher doses should be carefully justified by a clinician.
Special populations may need adjustments. In renal impairment, lower starting doses and slower titration may be appropriate. In moderate hepatic impairment, conservative dosing and close monitoring are advised; Nebivolol is generally not recommended in severe hepatic impairment. Older adults may require slower dose escalation. Genetic differences in CYP2D6 metabolism can influence plasma levels; patients who are poor metabolizers may experience stronger effects at standard doses, warranting careful clinical monitoring.
Take Nebivolol consistently to maintain even blood levels. Do not abruptly stop the medication, as sudden withdrawal can precipitate rebound hypertension or exacerbate ischemic heart disease in susceptible individuals. If discontinuation is necessary, clinicians usually taper the dose over one to two weeks while monitoring blood pressure, heart rate, and symptoms. Always follow the dosing plan provided by your prescriber.
Prior to starting Nebivolol, inform your clinician about your medical history, including asthma or COPD, diabetes, thyroid disorders, peripheral vascular disease, kidney or liver problems, depression, and any history of slow heart rhythms. While Nebivolol is beta‑1 selective, bronchospasm can still occur in sensitive individuals; caution is advised in reactive airway disease. In diabetes, beta blockers may mask adrenergic symptoms of hypoglycemia (such as tremor and palpitations), so glucose monitoring and patient education are essential.
Nebivolol can slow the heart rate and may worsen conduction abnormalities in patients with existing AV block or sick sinus syndrome. Use cautiously in patients with poor peripheral circulation (e.g., Raynaud’s) and in those with untreated pheochromocytoma, where appropriate alpha‑blockade should precede any beta blockade.
Discuss pregnancy and breastfeeding plans with your clinician. Beta blockers can affect fetal growth and neonatal physiology; risk‑benefit assessment is vital. Avoid alcohol excess and be cautious with activities requiring alertness until you know how Nebivolol affects you. This guide is informational and does not replace individualized medical advice.
Do not use Nebivolol if you have known hypersensitivity to the drug or any component of the formulation; severe bradycardia; sick sinus syndrome (unless a pacemaker is in place); second- or third-degree AV block (without a pacemaker); cardiogenic shock; decompensated heart failure requiring inotropic support; severe hypotension; or severe hepatic impairment. Use is generally contraindicated in severe peripheral circulatory disorders. In patients with pheochromocytoma, beta blockade without adequate alpha blockade is contraindicated. When in doubt, a clinician should review your full history and current medications to determine suitability.
Most people tolerate Nebivolol well, but side effects can occur. Common reactions include headache, dizziness, fatigue, nausea, diarrhea or constipation, and sleep disturbances. Some individuals notice a lower resting heart rate or mild cold extremities due to peripheral vasoconstriction, although Nebivolol’s nitric oxide–mediated vasodilation may mitigate this compared with older agents.
Less common effects include depression, anxiety, rash or pruritus, and erectile dysfunction or reduced libido. Clinically significant bradycardia, symptomatic hypotension, or worsening of heart block can occur, especially when combined with other rate‑slowing drugs. Bronchospasm is uncommon but possible, particularly in patients with reactive airway disease.
Seek urgent care for chest pain, fainting, severe shortness of breath or wheezing, signs of heart failure (rapid weight gain, swelling, increasing fatigue), severe dizziness, or allergic reactions (hives, facial swelling, throat tightness). Report persistent or bothersome effects to your prescriber; adjustments to dose, timing, or concomitant therapy can often improve tolerability.
Nebivolol is metabolized primarily by CYP2D6. Strong CYP2D6 inhibitors (such as paroxetine, fluoxetine, quinidine, bupropion) can raise Nebivolol levels, increasing the risk of bradycardia or hypotension; dose adjustments or alternative therapies may be considered. CYP inducers (e.g., rifampin) may reduce efficacy.
Additive heart‑rate and conduction effects can occur with non‑dihydropyridine calcium channel blockers (verapamil, diltiazem), digoxin, amiodarone, and certain antiarrhythmics. Co‑administration with other antihypertensives (ACE inhibitors, ARBs, diuretics, alpha‑blockers) can potentiate hypotension; careful titration and monitoring are advised.
Clonidine withdrawal can produce rebound hypertension; when both are used, clinicians often taper the beta blocker first before stopping clonidine. NSAIDs may blunt antihypertensive effects via sodium retention. Insulin and oral hypoglycemics can have amplified or masked effects; beta blockers may reduce awareness of hypoglycemia. Anesthetics and PDE‑5 inhibitors (sildenafil, tadalafil) can further lower blood pressure. Always share a complete list of prescriptions, OTC medications, and supplements—especially St. John’s wort, which can alter drug metabolism—with your healthcare provider.
If you miss a dose of Nebivolol, take it as soon as you remember on the same day. If it is almost time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at once to make up for a missed dose. Consistent daily timing helps maintain stable blood levels; consider using a reminder app or pill organizer to reduce the chance of missed doses.
Symptoms of Nebivolol overdose may include profound bradycardia, hypotension, heart block, acute heart failure, bronchospasm, and hypoglycemia. If an overdose is suspected, call emergency services immediately. In the U.S., you can also contact Poison Control at 1‑800‑222‑1222 for expert guidance.
Medical management typically involves airway and breathing support, IV fluids for hypotension, atropine for bradycardia, vasopressors if needed, glucagon to bypass beta‑receptor blockade, high‑dose insulin euglycemia therapy in severe cases, beta‑agonists for bronchospasm, and temporary pacing for high‑grade AV block. Early evaluation and supportive care improve outcomes.
Store Nebivolol tablets at controlled room temperature (typically 20–25°C/68–77°F), protected from moisture and excessive heat or light. Keep the medication in its original container with the label intact, out of reach of children and pets. Do not use tablets past their expiration date, and consult a pharmacist about safe disposal if therapy is discontinued.
In the United States, Nebivolol is a prescription‑only medication. Federal and state laws require an appropriate medical evaluation and a valid prescription before dispensing. This protects patients by ensuring the drug is indicated, the dose is suitable, interactions are reviewed, and ongoing monitoring is in place.
HealthSouth MountainView offers a legal, structured pathway to obtain Nebivolol through modern telehealth workflows. Rather than requiring an in‑person, paper prescription, you complete a secure online intake that is reviewed by a licensed clinician. When clinically appropriate, a prescription is issued and routed to a partnering, licensed pharmacy for fulfillment and delivery. This preserves all safeguards of traditional care—clinical oversight, verification, quality‑assured sourcing—while removing unnecessary friction for eligible adults.
Important: Services adhere to U.S. regulations. Nebivolol is not provided without clinician authorization, and availability may vary by state. If Nebivolol is not appropriate, you may be guided to alternatives or local care. Transparent pricing, privacy, and pharmacist counseling are included to help you start therapy confidently and responsibly.
Nebivolol is a cardioselective beta-blocker used to lower high blood pressure (hypertension), helping reduce the risk of heart attack and stroke; in some regions it’s also used for chronic heart failure, but in the United States it is approved for hypertension.
It blocks beta-1 receptors in the heart to slow heart rate and reduce cardiac workload, and uniquely enhances nitric oxide–mediated vasodilation in blood vessels, which lowers vascular resistance.
You may see a blood-pressure reduction within 1–2 weeks, with full effect often apparent by 2–4 weeks; heart-rate lowering is noticeable within hours to days.
Most adults start at 5 mg once daily, with adjustments between 2.5–40 mg based on response and tolerance; older adults or those with kidney or liver impairment often start at 2.5 mg once daily.
You can take it at the same time each day, morning or night; choose a time you can stick with and consider bedtime if you experience daytime dizziness or fatigue.
Take it when you remember unless it’s close to the next dose; do not double up—just resume your regular schedule.
No; abrupt discontinuation can cause rebound hypertension, rapid heart rate, or chest pain—taper over 1–2 weeks under medical guidance.
Fatigue, headache, dizziness, slow heart rate, nausea, and cold hands or feet are most common; many are mild and improve over time.
Severely slow heartbeat, fainting, wheezing or breathing trouble, new or worsening swelling/shortness of breath, severe depression, or allergic reactions (rash, swelling, trouble breathing) require urgent evaluation.
Beta-blockers can contribute to sexual side effects, but nebivolol’s nitric oxide–mediated vasodilation may lessen this risk compared with some others; discuss any changes in libido or erectile function with your clinician.
As a beta-1 selective agent it is generally safer than nonselective beta-blockers, but it can still provoke bronchospasm in sensitive individuals; use caution and monitor closely with your prescriber.
Alcohol can enhance blood-pressure–lowering and dizziness; if you drink, do so in moderation and be cautious when standing or driving.
Beta-blockers may cause fetal or newborn bradycardia and low blood sugar; use only if benefits outweigh risks, and discuss alternatives; limited data exist for breastfeeding, so monitor infants for drowsiness, feeding issues, or slow pulse.
Drugs that slow heart rate or AV conduction (diltiazem, verapamil, digoxin), clonidine (risk with abrupt withdrawal), other antihypertensives, and CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine) can increase effects; always review your medication list.
Yes; it can mask adrenergic symptoms of hypoglycemia (tremor, palpitations), though sweating may persist; monitor glucose closely and carry a source of fast-acting sugar.
It blunts heart-rate response to exercise, so use perceived exertion or a personalized plan rather than generic heart-rate targets; stay hydrated and warm up/cool down to reduce dizziness.
In some countries, nebivolol is indicated for stable chronic heart failure; in the U.S. it is not approved for heart failure, where carvedilol, metoprolol succinate, and bisoprolol are standard beta-blockers.
Mild weight gain or ankle swelling can occur but are less common; report rapid weight gain, leg swelling, or shortness of breath promptly.
Yes; check blood pressure and pulse at home, and your clinician may also monitor kidney function, blood glucose (if diabetic), and symptoms of dizziness or bradycardia.
Yes; generic nebivolol is available in many regions and can reduce cost compared with brand formulations such as Bystolic.
Both are beta-1 selective, but nebivolol also promotes nitric oxide–mediated vasodilation, which may improve tolerability (less fatigue or sexual dysfunction) for some; head-to-head blood-pressure lowering is broadly similar, so choice depends on comorbidities, side effects, and cost.
Both are highly beta-1 selective; nebivolol adds vasodilating effects, while bisoprolol has robust heart-failure evidence; for hypertension, efficacy is comparable—selection hinges on heart-failure status, heart rate control, and individual response.
Carvedilol blocks beta and alpha-1 receptors, offering strong vasodilation and proven mortality benefit in heart failure; nebivolol is more beta-1 selective with nitric oxide–mediated vasodilation and may be gentler on heart rate and sexual function; carvedilol may cause more dizziness and fatigue.
Atenolol is older, less lipophilic, and less selective at higher doses; nebivolol is more beta-1 selective and may have a better side-effect profile (metabolic neutrality, sexual function), with similar blood-pressure reduction.
Propranolol is nonselective and crosses the blood-brain barrier, making it useful for tremor, migraine prevention, and performance anxiety; nebivolol is preferred for hypertension when cardioselectivity and fewer CNS side effects are desired.
Labetalol (alpha-1 and nonselective beta blockade) is widely used and preferred for hypertension in pregnancy; nebivolol is not first-line in pregnancy due to limited data.
Nadolol is nonselective with a very long half-life (once-daily, renal elimination), used for portal hypertension and arrhythmias; nebivolol is cardioselective for hypertension with potential tolerability advantages and hepatic metabolism (CYP2D6).
No; timolol is nonselective and often used ophthalmically for glaucoma or orally for migraine; nebivolol is for systemic blood-pressure control and is more beta-1 selective.
Acebutolol has intrinsic sympathomimetic activity (partial agonist), potentially causing less resting bradycardia but sometimes less BP lowering; nebivolol lacks ISA and adds nitric oxide–mediated vasodilation, often yielding steadier BP control.
Sotalol is an antiarrhythmic with class III properties and significant QT prolongation risk; it’s used for atrial and ventricular arrhythmias, not routine hypertension—do not substitute sotalol for nebivolol without specialist guidance.
Esmolol is an ultra–short-acting IV beta-1 blocker for acute settings (e.g., perioperative tachycardia); nebivolol is oral, long-acting, for chronic blood-pressure control.
Metoprolol succinate has strong outcome data and guideline endorsement for heart failure; nebivolol has supportive data in older patients in some regions but is not universally approved for HF, so metoprolol succinate is generally preferred for HF.
Compared with older nonselective agents (e.g., atenolol, propranolol), nebivolol appears more neutral on glucose and lipids and may cause fewer metabolic side effects, though lifestyle and overall regimen remain key.
Both are reasonable; carvedilol may improve insulin sensitivity and is favored if heart failure is present, while nebivolol’s cardioselectivity and NO-mediated vasodilation can offer good BP control with potential tolerability benefits—individual factors and co-therapies guide the choice.
