Nebivolol/Hct Eg (Hydrochlorothiazide, Nebivolol)

Nebivolol/Hydrochlorothiazide is indicated for the management of hypertension, acting on the cardiovascular system to control elevated blood pressure.

• Essential hypertension: lowers systolic and diastolic pressure in patients with primary high blood pressure.
• Hypertension requiring diuretic therapy: provides additive blood‑pressure reduction through combined beta‑blockade and diuresis.
• Stage 1 hypertension: assists in achieving target blood‑pressure goals when lifestyle measures are insufficient.

• Nebivolol selectively blocks β1‑adrenergic receptors, reducing heart rate and myocardial contractility while also stimulating endothelial nitric‑oxide release, causing vasodilation. Hydrochlorothiazide inhibits sodium‑chloride reabsorption in the distal convoluted tubule, increasing urinary sodium and water excretion, which decreases plasma volume and peripheral resistance. Together, these actions synergistically lower systemic blood pressure.

Common Side Effects

• Dizziness: sensation of light‑headedness, especially after standing.
• Headache: mild to moderate pain often related to blood‑pressure changes.
• Fatigue: reduced energy or feeling unusually tired.
• Increased urination: due to the diuretic component.
• Electrolyte imbalance: mild changes in potassium or sodium levels.

Serious or Rare Side Effects

• Severe hypotension: markedly low blood pressure requiring medical attention.
• Acute kidney injury: sudden decline in renal function.
• Hyperuricemia or gout flare: elevated uric acid levels.
• Anaphylactic reaction: rare severe allergic response.

Before initiating therapy, consider the following precautions:

• Blood pressure monitoring: ensure adequate control and avoid excessive drops.
• Renal function assessment: evaluate kidney function, especially in patients with pre‑existing impairment.
• Electrolyte surveillance: check serum potassium and sodium periodically.
• Diabetes management: monitor blood‑glucose as beta‑blockers may mask hypoglycaemia symptoms.
• Hepatic impairment: use with caution in severe liver disease.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Nebivolol/Hydrochlorothiazide may interact with several medicines.

Major Interactions (Avoid)

• Other antihypertensives (e.g., ACE inhibitors, ARBs): additive blood‑pressure lowering effect may cause hypotension.
• Potassium‑sparing diuretics or supplements: risk of hyperkalaemia.
• NSAIDs (e.g., ibuprofen): may reduce diuretic efficacy and impair renal function.

Moderate Interactions (Monitor Closely)

• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): may increase nebivolol plasma levels.
• Lithium: concurrent use can raise lithium concentrations, risking toxicity.
• Antidiabetic agents: beta‑blockade may mask hypoglycaemia signs, requiring dose adjustments.