Nebivolol/Hydrochlorothiazide Teva (Hydrochlorothiazide, Nebivolol)

Nebivolol/Hydrochlorothiazide is indicated for hypertension, a condition characterized by elevated arterial pressure.

• Essential hypertension: lowers systolic and diastolic blood pressure through combined beta‑blockade and diuresis.
• Stage 2 hypertension: provides stronger blood‑pressure reduction when monotherapy is insufficient.
• Hypertension with fluid retention: addresses both vascular resistance and excess plasma volume.

• Nebivolol selectively blocks β1‑adrenergic receptors, reducing heart rate and myocardial contractility, while also stimulating endothelial nitric‑oxide release for vasodilation. Hydrochlorothiazide inhibits NaCl reabsorption in the distal convoluted tubule, increasing urinary sodium and water excretion, thereby decreasing plasma volume and peripheral resistance. The complementary actions result in additive blood‑pressure lowering.

Common Side Effects

• Dizziness: transient light‑headedness, especially after the first doses.
• Headache: mild to moderate intensity, often resolves with continued therapy.
• Fatigue: feeling of tiredness or reduced energy.
• Increased urination: due to the diuretic component.
• Electrolyte imbalance (mild): slight changes in potassium or sodium levels.
• Nausea: occasional stomach upset.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure causing fainting.
• Hyponatremia or hypokalemia: significant electrolyte disturbances requiring monitoring.
• Gout flare: increased uric acid levels may precipitate attacks.
• Acute renal impairment: reduced kidney function, especially in patients with pre‑existing renal disease.
• Allergic reactions: rash, itching, or swelling of the face and throat.
• Pancreatitis: rare inflammation of the pancreas presenting with abdominal pain.

Before initiating therapy, consider the following precautions:

• Renal function: assess creatinine clearance and adjust if necessary.
• Electrolytes: monitor serum potassium and sodium regularly.
• Diabetes mellitus: watch for altered glucose control.
• Asthma or COPD: beta‑blockade may exacerbate bronchospasm.
• Pregnancy: avoid unless the potential benefit justifies the risk.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Nebivolol/Hydrochlorothiazide may interact with several drug classes.

Major Interactions (Avoid)

• Non‑selective beta‑blockers: additive bradycardia and AV‑block.
• Potassium‑sparing diuretics: risk of hyperkalemia.
• Lithium: increased lithium toxicity.
• NSAIDs: may blunt diuretic efficacy and worsen renal function.
• Antidiabetic agents: may mask hypoglycaemia symptoms.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: enhanced hypotensive effect.
• Calcium channel blockers: additive blood‑pressure reduction.
• SSRIs or other antidepressants: potential for increased bradycardia.