Nurses Compass
Drug Guide
Nebivolol Hydrochloride
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.