Bystolic (nebivolol) is a beta-adrenergic receptor blocking agent indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents. This cardioselective beta-blocker offers a unique hemodynamic profile, combining beta-1 receptor blockade with vasodilatory properties through modulation of the endothelial L-arginine/nitric oxide pathway. Its pharmacological profile makes it a valuable option in the management of elevated blood pressure, particularly for patients who may benefit from its favorable side effect characteristics and metabolic neutrality.

Features

• Active ingredient: Nebivolol hydrochloride
• Available in 2.5 mg, 5 mg, 10 mg, and 20 mg tablet strengths
• Cardioselective beta-1 adrenergic receptor blocker
• Vasodilatory properties via endothelial nitric oxide potentiation
• Once-daily dosing regimen
• FDA-approved for hypertension treatment
• Available as film-coated tablets

Benefits

• Effectively lowers both systolic and diastolic blood pressure through dual mechanism of action
• Demonstrates cardioselectivity at therapeutic doses, reducing pulmonary and metabolic side effects
• Shows neutral or beneficial effects on metabolic parameters including lipid profiles and insulin sensitivity
• May improve endothelial function through nitric oxide-mediated vasodilation
• Generally well-tolerated profile with lower incidence of traditional beta-blocker side effects
• Suitable for long-term management of hypertension with once-daily dosing convenience

Common use

Bystolic is primarily prescribed for the treatment of hypertension in adults. It works by blocking beta-1 adrenergic receptors in the heart, which reduces heart rate and cardiac output, while its vasodilatory effect decreases peripheral vascular resistance. This dual mechanism provides comprehensive blood pressure control. Clinical studies have demonstrated its efficacy across diverse patient populations, including those with metabolic syndrome and elderly patients. It is often selected for patients who experience side effects with traditional beta-blockers or those requiring a metabolically neutral antihypertensive option.

Dosage and direction

The recommended starting dose of Bystolic is 5 mg once daily, with or without food. Dosage may be increased at 2-week intervals up to the maximum recommended dose of 40 mg once daily. The dose should be individualized based on patient response and tolerability. For patients with severe renal impairment (CrCl less than 30 mL/min) or moderate hepatic impairment (Child-Pugh Class B), the recommended initial dose is 2.5 mg once daily; upward titration should be performed cautiously. Tablets should be swallowed whole and not crushed or chewed. Blood pressure response should be monitored regularly, especially during dose adjustments.

Precautions

Patients should be monitored for signs and symptoms of excessive bradycardia. Abrupt discontinuation should be avoided, as beta-blocker withdrawal syndrome may occur. Use with caution in patients with compensated heart failure. May mask signs of hypoglycemia in diabetic patients. Can potentially exacerbate symptoms in patients with peripheral vascular disease. Use cautiously in patients with bronchospastic disease who do not respond to bronchodilator therapy. May cause dizziness or fatigue, affecting ability to drive or operate machinery. Regular monitoring of blood pressure, heart rate, and renal function is recommended during therapy.

Contraindications

Bystolic is contraindicated in patients with severe bradycardia, heart block greater than first degree, cardiogenic shock, decompensated cardiac failure, sick sinus syndrome (unless a permanent pacemaker is present), severe hepatic impairment (Child-Pugh Class C), and in patients who are hypersensitive to any component of this product. Should not be used in patients with bronchospastic disease who require bronchodilator therapy. Contraindicated in patients with pheochromocytoma without concomitant alpha-blockade.

Possible side effect

Common adverse reactions (≥2% and more frequent than placebo) include headache, fatigue, dizziness, diarrhea, nausea, insomnia, bradycardia, dyspnea, rash, and peripheral edema. Less frequent but potentially serious side effects may include worsening heart failure, AV block, bronchospasm, masking of hypoglycemia symptoms, and Raynaud’s phenomenon. Some patients may experience sexual dysfunction, depression, or vivid dreams. Laboratory abnormalities may include increased blood urea nitrogen, serum triglycerides, or liver function tests. Most side effects are dose-dependent and often diminish with continued therapy or dose reduction.

Drug interaction

Bystolic may potentiate the effects of other antihypertensive agents. Concomitant use with other beta-blockers or calcium channel blockers may increase risk of bradycardia and AV block. CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine) may increase nebivolol levels. May enhance insulin-induced hypoglycemia and mask warning signs. Concurrent use with digoxin may increase digoxin levels. NSAIDs may reduce antihypertensive effect. May interact with antiarrhythmics, catecholamine-depleting drugs, and MAO inhibitors. Use with clonidine may potentiate rebound hypertension upon discontinuation.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is almost time for the next dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose. Consistent daily administration at approximately the same time each day is recommended for optimal blood pressure control. If multiple doses are missed, patients should contact their healthcare provider before resuming therapy, as dose adjustment may be necessary.

Overdose

Symptoms of overdose may include severe bradycardia, hypotension, heart failure, bronchospasm, hypoglycemia, and cardiac arrest. Management should include close monitoring of vital signs and ECG. Gastric lavage may be considered if ingestion was recent. Atropine can be administered for bradycardia. Intravenous fluids and vasopressors may be required for hypotension. Glucagon may be effective for reversing cardiovascular effects. Cardiac pacing may be necessary for unresponsive bradycardia. Bronchodilators should be available for bronchospasm. Hemodialysis is unlikely to be effective due to high protein binding.

Storage

Store at room temperature between 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in original container with lid tightly closed. Protect from light and moisture. Keep out of reach of children and pets. Do not use if the seal is broken or tablets appear damaged. Properly discard any unused medication after the expiration date. Do not flush medications down the toilet or pour into a drain unless instructed to do so.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Bystolic is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual results may vary. Patients should not discontinue or change their dosage without consulting their physician. The complete prescribing information should be consulted before initiating therapy. This summary does not include all possible information about this medication and cannot replace professional medical advice.

Reviews

Clinical studies demonstrate Bystolic’s efficacy in reducing blood pressure with a generally favorable side effect profile. Many physicians note its usefulness in patients intolerant to other beta-blockers. Patients often report better quality of life compared to traditional beta-blockers, with less fatigue and sexual dysfunction. However, individual responses vary, and some patients may experience side effects requiring dose adjustment or discontinuation. Long-term studies show maintained efficacy and good tolerability over extended treatment periods. Real-world evidence supports its position as a valuable option in hypertension management algorithms.