Renal Dose Adjustment (Based on CrCl)
- Mild renal impairment 50-80 mL/min: Dose adjustment not defined
- Moderate renal impairment 30-50 mL/min: Dose adjustment not defined
- Severe Renal impairment <30 mL/min): Start 2.5 mg PO Daily. Titrate dose if needed
Hepatic Dose Adjustment
- Mild hepatic impairment (Child-Pugh Class A): Dose adjustment not defined
- Moderate hepatic impairment (Child-Pugh Class B): Start 2.5 mg PO Daily. Titrate dose if needed
- Severe hepatic impairment (Child-Pugh Class C): Contraindicated
- Carefully observe and advise patient to minimize physical activity when they are planning to discontinue the therapy. Re-start the therapy if angina worsens or acute coronary insufficiency develops
- Avoid using ß-blocker with bronchospastic disease
- Withdrawal of therapy has been associated with an increased risk of MI and chest pain. Instruct patient already on beta-blockers to continue the treatment throughout the perioperative period
- Worsening of angina, MI and ventricular arrhythmias have occurred in patients with coronary artery disease after discontinuation of therapy
- Nebivolol may cover signs of hyperthyroidism (eg, tachycardia); abrupt withdrawal of this therapy may worsen symptoms of hyperthyroidism or potentiate thyroid storm
- Closely monitor the patient when anesthetic agents which depress myocardial function are used. If therapy is withdrawn prior to major surgery, the impaired ability of the heart to respond to reflex adrenergic stimuli may increase the risks of general anesthesia and surgical procedures
- Therapy may mask symptoms of hypoglycemia; nonselective beta-blockers may potentiate insulin-induced hypoglycemia and may also delay recovery of serum glucose levels
- Therapy may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease
- Monitor ECG and blood pressure in patients treated concomitantly with these agents
- Exposure to this drug may increase with inhibition of CYP2D6; consider reduction of dose
- Patients with a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge while taking nebivolol
Cautions: Use cautiously in
- Sever renal impairment
- Moderate hepatic impairment
- Compensated CHF
- Angina
- Recent MI
- Bronchospastic disease
- Peripheral vascular disorder
- Anesthesia or surgery
- Diabetes mellitus
- Hypoglycemia
- Thyroid disorder
- History of severe anaphylactic reaction
- Concomitant use of calcium channel blockers
- Concomitant use of clonidine
- Pheochromocytoma
- Pregnancy 2nd or 3rd trimester
- Breastfeeding
- Thyrotoxicosis
Pregnancy Category:C
Breastfeeding: Safety unknown. Use not recommended.
Pricing data from www.DrugStore.com in U.S.A.
- Bystolic 5 MG TABS [Bottle] (FOREST)
30 mg = $71.99
90 mg = $207.98 - Bystolic 2.5 MG TABS [Bottle] (FOREST)
30 mg = $73.19
90 mg = $201.92 - Bystolic 20 MG TABS [Bottle] (FOREST)
30 mg = $74.51
90 mg = $199.49 - Bystolic 10 MG TABS [Bottle] (FOREST)
30 mg = $71.99
90 mg = $199.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
