Symptomatic hyponatremia when combined with carbamazepine

Predisposes to allopurinol sensitivity reactions and impaired renal function.

Potentiates hypotensive effects of beta blockers and ACE inhibitors, These also reduce diuretic- induced hypokalemia

Enhance neuromuscular action of blocking action of muscle relaxants.

Cross allergy with sulphonyl urea hypoglycemics with resultant active interstistial nephritis and vasculitis Pototentiates bone marrow suppresion caused by anticancer drugs.

Potentiates aminoglycoside nephrotoxicity Impaired control of diabetes by oral hypoglycemic agents

May precipitate lithium and digitalis toxicity .

Increased risk of hypkalemia with corticosteroids. Prolonged paralysis caused by tubercuraine

Hypertension

Nebivolol- Long term toleralbility og nebivolol monotherapy found that nebivolol was well tolerated with a low incidence of drug- related adverse effects such as tiredness, cold estremities, impotence, and shortness of breath

Hydrochlorthiazide- Hypotension includes orthostatic hypotension (may be aggravated by alcohol, barbiturates, narcotics or anti-hypertensives drugs) pancreatitis, jaundice, (interhepatic cholestatic jaundice) diarrhea, vomiting, saladentitis, cramping, constipation, gastric irritation, nausea, anorexia, thrombocytopenia, photosensitivity, fever, urticaria, rash, purpura, htperglycemia, glycosuria, hyperuricemia, dizziness, headache, restlessness, inpotence

Nebivolol- Hypersensitivity to the active substance, or any of the excipients, liver insufficiency or liver function impairment, sulponamide allergy pregancy and lactation. Hydrochlorthiazide- Anuria, lactation, sulphonamide allergy.

Special precaution-

History of allergies, psoriasis, hyperthyroidism, peripheral artterial disease, diabetes, existing electrolyte disturbances, oedema, renal impairment

Dosage-

Nevibiol 5mg + Hydrochlor thiaz 12.5mg 1 tab once daily

Pharmacology-

Nebivolol is a lipophilic beta1 blocker administered clinically as a racemic mixture of equal proposiotions of its d- and l- enatiomers. The drug is devoid of intrinsic sympathomimetic or membrane stabilizing activity but appears to have a nitric oxide-mediated vasodilatory effect. A dose related reduction in clinic and ambulatory blood pressure was demonstrated for each drug as monotherapy and for two drugs in combination. Nebivolol has additive effects with hydrochlorthiazide . Combination therapy produced an additive dose-related reduction in mean diastolic blood pressure.

Nebivolol- pregancy and lactation. Hydrochlorthiazide- lactation