Nebilet Plus (Hydrochlorothiazide, Nebivolol)

Nebilet Plus is indicated for the management of high blood pressure within the antihypertensive drug class.

• Essential hypertension: reduces systolic and diastolic pressure to target levels.
• Secondary hypertension: assists in controlling blood pressure when caused by another condition.
• Isolated systolic hypertension: helps lower elevated systolic readings in older adults.

• Nebivolol selectively blocks β1‑adrenergic receptors, decreasing heart rate and myocardial contractility, while also stimulating endothelial nitric‑oxide release, producing vasodilation. Hydrochlorothiazide inhibits Na⁺/Cl⁻ reabsorption in the distal convoluted tubule, increasing urinary sodium and water excretion, which lowers plasma volume and contributes to blood‑pressure reduction.

Nebilet Plus may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Headache: mild to moderate intensity.
• Dizziness or light‑headedness: especially on standing.
• Fatigue: general tiredness.
• Increased urination: due to diuretic effect.
• Electrolyte imbalance: low potassium or sodium.
• Cough: occasional dry cough.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure.
• Bradycardia: abnormally slow heart rate.
• Acute kidney injury: reduced renal function.
• Allergic reactions: rash, itching, or swelling.
• Hyperglycaemia: elevated blood glucose levels.
• Electrolyte disturbances: severe hyponatraemia or hypokalaemia.

Before initiating therapy with Nebilet Plus, consider the following safety measures.

• Renal impairment: assess kidney function and monitor electrolytes.
• Hepatic disease: use with caution in patients with liver dysfunction.
• Diabetes mellitus: monitor blood glucose as diuretics may affect control.
• Gout: watch for increased uric acid levels.
• Pregnancy and lactation: evaluate risk‑benefit ratio; use only if clearly needed.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Nebilet Plus can interact with several medicines; awareness of these interactions helps maintain therapeutic effectiveness.

Major Interactions (Avoid)

• Strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): may increase nebivolol levels.
• Other antihypertensives (e.g., ACE inhibitors, ARBs): risk of excessive blood‑pressure lowering.
• Lithium: thiazide component can raise lithium concentrations.

Moderate Interactions (Monitor Closely)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may reduce diuretic efficacy.
• Antidiabetic agents: thiazide may impair glucose control.
• Calcium channel blockers: additive effect on heart rate and blood pressure.