Bystolic: Adult Dosing

Dosage forms: 2.5,5,10

HTN

5-40 mg PO qd

Start: 5 mg PO qd; Max: 40 mg/day; Info: may incr. dose q2wk

renal dosing

adjust dose amount

CrCl <30: start 2.5 mg qd; HD/CAPD: not defined

hepatic dosing

see below

Child-Pugh Class B: start 2.5 mg qd; Child-Pugh Class C: contraindicated

Bystolic: Peds Dosing

This information is currently unavailable or not applicable for this drug.

Bystolic: Contraindications/Cautions

• hypersens. to drug/class/compon.
• sinus bradycardia
• AV block, 2nd or 3rd degree
• heart failure, uncompensated
• cardiogenic shock
• sick sinus syndrome w/o pacemaker
• hepatic impairment, severe (Child-Pugh Class C)
• avoid abrupt withdrawal
• caution if CHF, compensated
• caution if angina
• caution if recent MI
• caution if bronchospastic dz
• caution if peripheral vascular dz
• caution if anesthesia/surgery
• caution if diabetes mellitus
• caution if hypoglycemia
• caution if thyroid disorder
• caution if impaired renal fxn, severe
• caution if impaired liver fxn, moderate
• caution if severe anaphylactic rxn hx
• caution if pheochromocytoma
• caution in pregnancy, 2nd or 3rd trimester
• caution if breastfeeding

Bystolic: Drug Interactions

Avoid/Use Alternative

• central alpha 2 agonists

• cimetidine

• cocaine topical

• COX 2 inhibitors

• fenoldopam

• hydrocodone/ibuprofen

• ibuprofen/oxycodone

• insulins

• lansoprazole/naproxen

• NSAIDs

Monitor/Modify Tx

• acetaminophen/propoxyphene

• alpha 2 agonists, ophthalmic

• alpha 2 agonists/beta blockers, ophthalmic

• amiodarone

• amitriptyline/perphenazine

• antihist/decongestant combos

• aspirin/butalbital/caffeine

• aspirin/butalbital/caffeine/codeine

• aspirin/caffeine/dihydrocodeine

• aspirin/caffeine/orphenadrine

• aspirin/dipyridamole

• aspirin/muscle relaxant combos

• aspirin/opiate combos

• atazanavir

• beta blockers, ophthalmic

• bismuth subsalicylate/metronidazole/tetracycline

• bupropion

• CCBs, others

• chlorpromazine

• cinacalcet

• dexmedetomidine

• diazoxide

• digoxin

• duloxetine

• fluvoxamine

• haloperidol

• hypoglycemics, other

• imatinib

• inhaled anesthetics

• lanreotide

• lopinavir/ritonavir

• maraviroc

• mefloquine

• meperidine/promethazine

• metformin/sulfonylurea combos

• octreotide

• olanzapine/fluoxetine

• perphenazine

• pramlintide

• promethazine

• promethazine/codeine

• propafenone

• propoxyphene

• quinidine

• ranolazine

• ritonavir

• salicylates, non-acetylated

• sildenafil

• SSRIs 1 (2D6 inhibitors)

• sumatriptan/naproxen sodium

• terbinafine

• thiazolidinediones

• thioridazine

• tipranavir

• tizanidine

Caution Advised

• alfentanil

• alpha blockers, non-selective

• antihist/decongest/DM combos

• apomorphine

• beta 2 agonists, all

• cetirizine/pseudoephedrine

• cholinergic agents

• cholinesterase inhibitors

• cyclopentolate/phenylephrine ophthalmic

• decongest/opiate combos

• decongestants

• decongestants, intranasal

• diclofenac topical

• disopyramide

• epinephrine, inhaled

• ergot alkaloids

• ergotamine/caffeine

• fibric acid derivatives

• flecainide

• fluphenazine

• iloprost inhaled

• local anesthetics/epinephrine

• MAOIs, non-selective

• morphine liposomal

• niacin

• niacin/lovastatin

• niacin/simvastatin

• nitrites/sodium thiosulfate

• omega-3-acid

• phenylephrine ophthalmic

• prochlorperazine

• reserpine

• sitagliptin

• sotalol

• sufentanil

• sulfonylureas

• sympathomimetics, direct

• sympathomimetics, indirect/mixed

• tadalafil

• trifluoperazine

Bystolic: Adverse Reactions

Serious Reactions

• CHF
• heart block
• bradycardia
• chest pain
• dyspnea
• bronchospasm

Common Reactions

• headache
• fatigue
• dizziness
• diarrhea
• nausea
• insomnia
• rash
• peripheral edema

Bystolic: Safety Monitoring

Pregnancy: C, see Contraind/Caut.

Lactation: Safety Unknown

Monitoring Parameters: Cr, LFTs at baseline; HR

Avoid Abrupt Cessation: taper dose gradually over 1-2wk to D/C (abrupt cessation of certain beta-blockers in CAD pts may cause angina exacerbation, MI, and ventricular arrhythmias)

Bystolic: Pharmacology

Metabolism: liver extensively; CYP450: 2D6 substrate; Info: active metabolites

Excretion: urine 38% (none unchanged), feces 44% (none unchanged); Half-life: 12-19h

Class: Beta-Blockers

Mechanism Of Action
selectively antagonizes beta1-adrenergic receptors

Bystolic: Manufacturer/Pricing

Manufacturer: Forest Pharmaceuticals DEA/FDA: Rx Approximate Retail Price tablet: 5 mg (30 ea): $55.99 10 mg (30 ea): $56.99

Bystolic: Patient Education

• Generic Name: nebivolol

• Pronounced: ne BIV oh lol

• Brand Name: Bystolic

What is the most important information I should know about nebivolol?

Do not skip doses or stop taking nebivolol without first talking to your doctor. Stopping suddenly may make your condition worse or cause other serious heart problems such as severe chest pain or heart attack. You may need to use less and less before you stop the medication completely.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using nebivolol. You may need to stop using the medicine for a short time.

Nebivolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Nebivolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

Hypertension often has no symptoms, so you may not even feel that you have high blood pressure. Continue using this medicine as directed, even if you feel well. You may need to use blood pressure medication for the rest of your life.

What is nebivolol?

Nebivolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

Nebivolol is used to treat hypertension (high blood pressure).

Nebivolol may also be used for other purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking nebivolol?

Do not use this medication if you are allergic to nebivolol or if you have:

• severe liver disease; or
• a heart problem such as heart block, sick sinus syndrome, slow heart rate, or heart failure.

Before taking nebivolol, tell your doctor if you are allergic to any drugs, or if you have:

• asthma, bronchitis, emphysema;
• liver or kidney disease;
• diabetes;
• a thyroid disorder;
• problems with circulation (such as Raynaud's syndrome);
• pheochromocytoma; or
• if you have recently had a heart attack.

If you have any of these conditions, you may not be able to use nebivolol, or you may need a dose adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether nebivolol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take nebivolol?

Take nebivolol exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label.

Take nebivolol at the same time every day. You may take the medication with or without food.

Do not skip doses or stop taking nebivolol without first talking to your doctor. Stopping suddenly may make your condition worse or cause other serious heart problems such as severe chest pain or heart attack. You may need to use less and less before you stop the medication completely.

To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Do not miss any scheduled appointments.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using nebivolol. You may need to stop using the medicine for a short time.

Nebivolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

Hypertension often has no symptoms, so you may not even feel that you have high blood pressure. Keep using this medicine as directed, even if you feel well. You may need to use blood pressure medication for the rest of your life.

Store nebivolol at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include slow heart rate, dizziness, vomiting, trouble breathing, or feeling like you might pass out.

What should I avoid while taking nebivolol?

Nebivolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

What are the possible side effects of nebivolol?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• feeling short of breath, even with mild exertion;
• swelling of your ankles or feet;
• slow or uneven heartbeats; or
• numbness or cold feeling in your hands and feet.

Less serious side effects may include:

• headache;
• tired feeling;
• nausea, stomach pain;
• diarrhea; or
• sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect nebivolol?

Before taking nebivolol, tell your doctor if you are using:

• digitalis (digoxin, Lanoxin);
• clonidine (Catapres);
• reserpine;
• guanethidine (Ismelin);
• a heart medication such as nifedipine (Procardia, Adalat), reserpine (Serpasil), verapamil (Calan, Verelan, Isoptin), diltiazem (Cartia, Cardizem);
• heart rhythm medicine such as amiodarone (Cordarone, Pacerone), disopyramide (Norpace), procainamide (Procan, Pronestyl), propafenone (Rythmol), quinidine (Quinidex, Quin-Release Quin-G), and others;
• an antidepressant such as fluoxetine (Prozac), paroxetine (Paxil), and others; or
• another beta-blocker such as atenolol (Tenormin), bisoprolol (Zebeta), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), propranolol (Inderal, InnoPran), sotalol (Betapace), or timolol (Blocadren), and others.

This list is not complete and there may be other drugs that can interact with nebivolol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about nebivolol.

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Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.

Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides.

The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Bystolic: Pill Pictures

This information is currently unavailable or not applicable for this drug.