Anaesthetics, clonidine, MAOIs, calcium antagonists (verapramil ) diltiazem ) anti-arrhythmetics, antidepressants, barbiturates, phenothiazines, Cardiac glycosides, antipsychotics, NSAIDs, fluvaxamine, cimetidine, hydralazine, Insulin/ oral hypoglcaemics, ergot derivatives, Diuretics, erythromycin, antimalarials, rifampicin, moxisylate

Nebivolol is well tolerated in patients with hypertension. Adverse reactions are typically transient and mild to moderate, the type. severity and frequency are dose related These include- Headache, fatigue, paraesthesis and dizziness. Several studies have also reported to signs of orthostatic hypotension with nebivolol

Use of this drug in children and patients with heaptic renal insufficieny is not recommended

Date of Approval        2004

Indications-

Essential hypertension

Dosage- Recommended dosage is 5mg once daily taken with or without food , preferably at a fixed time in a day. A reduced starting dose of 2.5mg (with upward titration where necessary) is recomended in the elderly and in patients with renal with renal insufficiency

Patient information-

Patients with inadequate cardiac function,well compensated heart faiure,myastenia gravis.Patients undergoing major surgery involoving general annesthesia.

May mask signs and symptoms of hypoglycemia and hypothrytoidism. Abruprt wirhdrwal may exeraburate anigina symptoms 

Pregnancy and lactation.

Monitoring parameters- monitor ECG, blood pressure and blood glucose in diabetic patients

Pharmacology:

Nebivolol is a lipophilic beta 1- blocker. It exerts its action by exhibiting a high selectivity for Beta-adrenergic receptors and also by reducing the peripheral vascular resistence by modulating NO release. It is devoid of intrinsic sympathomimetic or membrane stabilising activity but appears to have nitric oxide-mediated vasodilatory effects.

Pharmacokinetics:

After oral administration nebivolol achieves steady-state plasma concentrations with 1 day, and its active metabolite within a few days for the active metabolite.The metabolism of nebivolo is subject to genetic polymorphism, phenotypically, individuals may be characterised as poor (slow) or extensive (fast) metabolisers. One week after administration, 38% and 48% respy, of nebivolol dose is excreted in urine and faeces, unchanged nebivolol accounts for less than 0.05% of the amount recovered in the urine.Plasma concentrations of nebivolol (both enatiomers) and its hydroxy metabolites are elevated in patients with renal disease

Can be taken with or without food

Not recommended for use in children