Nebivolol Teva-Ratiopharm (Nebivolol Hydrochloride)

• Nebivolol is a selective β1‑adrenergic antagonist used in cardiovascular therapy.
• Hypertension: lowers elevated blood pressure in adult patients.
• Heart failure: improves cardiac function and reduces symptoms in patients with chronic heart failure.

• Nebivolol selectively blocks β1‑adrenergic receptors in the heart, decreasing heart rate and myocardial contractility, which reduces cardiac output and blood pressure. In addition, it stimulates endothelial nitric‑oxide synthase, causing nitric‑oxide‑mediated vasodilation that further contributes to blood pressure reduction.

Nebivolol may cause a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Headache: mild to moderate intensity.
• Dizziness or light‑headedness: especially on standing.
• Fatigue or tiredness: general lack of energy.
• Nasal congestion: feeling of a blocked nose.
• Gastrointestinal discomfort: nausea or abdominal pain.
• Bradycardia: slower than normal heart rate.

Serious or Rare Side Effects

• Severe bradycardia: may require medical attention.
• Hypotension: dangerously low blood pressure.
• Bronchospasm: difficulty breathing, especially in asthmatic patients.
• Heart block: impaired electrical conduction of the heart.
• Acute heart failure exacerbation: worsening of heart failure symptoms.
• Allergic reactions: rash, itching, swelling, or anaphylaxis.

• Before initiating therapy with Nebivolol, consider the following safety measures.
• Cardiovascular assessment: evaluate heart rate and blood pressure baseline.
• Asthma or chronic obstructive pulmonary disease: use with caution due to potential bronchospasm.
• Diabetes mellitus: monitor blood glucose as beta‑blockade may mask hypoglycaemia symptoms.
• Severe liver impairment: dose adjustment may be required.
• Pregnancy and lactation: use only if clearly needed after risk‑benefit evaluation.
• Store at ambient temperature: keep below 25 °C, retain in original packaging, protect from moisture and direct sunlight.

Nebivolol can interact with several medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Combined use with other β‑blockers: risk of excessive bradycardia and hypotension.
• Strong CYP2D6 inhibitors (e.g., paroxetine, quinidine): may increase nebivolol plasma levels.
• Calcium channel blockers (verapamil, diltiazem): additive negative inotropic and AV‑node effects.

Moderate Interactions (Monitor Closely)

• Antihypertensive agents (ACE inhibitors, diuretics): monitor for additive blood pressure lowering.
• Antidiabetic drugs (insulin, sulfonylureas): observe for masked hypoglycaemia signs.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may reduce antihypertensive effect.