Home Drug Guide Nebivolol Hydrochloride

Drug Guide

Generic Name

Nebivolol Hydrochloride

Brand Names Bystolic

Classification

Therapeutic: Beta-adrenergic blocking agent, antihypertensive

Pharmacological: Beta-1 adrenergic receptor blocker with vasodilatory properties

FDA Approved Indications

  • Hypertension

Mechanism of Action

Selective beta-1 adrenergic receptor blockade reducing heart rate, myocardial contractility, and cardiac output; also induces vasodilation via nitric oxide release.

Dosage and Administration

Adult: Start with 5 mg once daily; can titrate up to 40 mg daily based on response. Dose adjustments may be necessary for renal impairment and other comorbidities.

Pediatric: Not approved for pediatric use.

Geriatric: Initiate at lower doses; monitor renal function and blood pressure closely.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; no specific dose adjustments established.

Pharmacokinetics

Absorption: Well absorbed orally, with high bioavailability.

Distribution: Extensively distributed; protein binding approximately 98%.

Metabolism: Partially metabolized in the liver via CYP2D6.

Excretion: Primarily excreted in urine; also in feces.

Half Life: Approximately 12 hours.

Contraindications

  • Sinus bradycardia
  • Second- or third-degree atrioventricular block
  • Cardiogenic shock
  • Severe hepatic impairment

Precautions

  • Use with caution in patients with asthma, diabetes, peripheral vascular disease, and heart failure. Monitor for signs of worsening heart failure or bronchospasm.

Adverse Reactions - Common

  • Headache (Frequent)
  • Dizziness (Common)
  • Fatigue (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • Bradycardia (Uncommon)
  • Hypotension (Uncommon)
  • Worsening heart failure (Uncommon)
  • Bronchospasm (Uncommon)

Drug-Drug Interactions

  • IVERmectin, Diltiazem, Verapamil may increase risk of bradycardia or hypotension.

Drug-Food Interactions

  • Caffeine may diminish the antihypertensive effect.

Drug-Herb Interactions

  • St. John’s Wort may decrease effectiveness.

Nursing Implications

Assessment: Monitor blood pressure, heart rate, and for signs of heart failure.

Diagnoses:

  • Risk of decreased cardiac output
  • Risk of hypotension

Implementation: Administer with food if gastrointestinal upset occurs; monitor vital signs regularly.

Evaluation: Assess for effective blood pressure control and absence of adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not discontinue abruptly to avoid withdrawal symptoms.
  • Notify healthcare provider if experiencing dizziness, slow heart rate, or shortness of breath.
  • Limit alcohol intake and avoid sudden position changes.

Special Considerations

Black Box Warnings:

  • Use with caution in patients with severe bradycardia, bronchospasm, or decompensated heart failure.

Genetic Factors: CYP2D6 poor metabolizers may have increased plasma concentrations.

Lab Test Interference: May interfere with certain laboratory tests such as serum glucose levels.

Overdose Management

Signs/Symptoms: Severe bradycardia, hypotension, cardiogenic shock, bronchospasm, cardiac arrest.

Treatment: Supportive care, atropine for bradycardia, intravenous fluids, vasopressors for hypotension, and airway management as needed.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stability generally maintained until expiration date on packaging.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.