Nebilet Plus (Hydrochlorothiazide, Nebivolol)

• Nebilet Plus is indicated for the management of elevated arterial pressure within the antihypertensive drug class.
• Hypertension: reduces systolic and diastolic blood pressure in adults with primary hypertension.
• Essential hypertension: provides combined beta‑blockade and diuretic action for sustained pressure control.
• Stage 2 hypertension: offers an intensified therapeutic option when monotherapy is insufficient.

• Nebivolol selectively blocks β1‑adrenergic receptors, decreasing heart rate and myocardial contractility while also stimulating nitric‑oxide release for vasodilation. Hydrochlorothiazide inhibits Na⁺/Cl⁻ reabsorption in the distal convoluted tubule, increasing urinary sodium and water excretion, which lowers plasma volume and peripheral resistance. The combined actions result in a synergistic reduction of systemic blood pressure.

Common Side Effects

• Dizziness or light‑headedness
• Headache
• Fatigue or weakness
• Cold extremities
• Nausea or abdominal discomfort
• Increased urinary frequency

Serious or Rare Side Effects

• Severe hypotension or syncope
• Electrolyte disturbances such as hypokalemia
• Acute gout attacks
• Renal function impairment
• Allergic reactions including rash or angioedema
• Pancreatitis or severe abdominal pain

• Before initiating therapy, clinicians should evaluate cardiovascular status and renal function, and monitor electrolytes during treatment.
• Monitor blood pressure regularly: adjust dose if target not achieved.
• Assess renal function: avoid in severe renal impairment.
• Check serum electrolytes: especially potassium and sodium.
• Use caution in diabetic patients: may mask hypoglycaemia symptoms.
• Avoid abrupt discontinuation: taper to prevent rebound hypertension.
• Store at room temperature: keep in the original pack, protect from moisture.

Nebilet Plus may interact with several drug classes; awareness of interaction severity guides clinical decisions.

Major Interactions (Avoid)

• Concomitant use with other β‑blockers: risk of excessive bradycardia.
• Potent CYP2D6 inhibitors (e.g., paroxetine, quinidine): increase nebivolol levels.
• Other thiazide or loop diuretics: heightened electrolyte loss.
• Non‑selective β‑blockers: additive cardiovascular depression.
• MAO inhibitors: potential for severe hypotension.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: may enhance hypotensive effect.
• NSAIDs: can reduce diuretic efficacy and affect renal function.
• Lithium: increased risk of lithium toxicity.
• Antidiabetic agents: may require dose adjustment.
• Calcium channel blockers: possible additive heart‑rate reduction.