Nebilet

Nebivolol

Stable mild & moderate chronic heart failure in addition to standard therapies in elderly ≥70 yr. Essential HTN.

Chronic heart failure Initially 1.25 mg once daily, increase stepwise at 1-2 wkly intervals depending on patient's tolerability to 2.5, 5 & then 10 mg once daily. Max: 10 mg once daily. HTN Adult 5 mg daily. Elderly >65 yr & renal impairment Initially 2.5 mg daily, may be increased to 5 mg.

May be taken with or without food.

Hypersensitivity. Acute heart failure, cardiogenic shock or episodes of heart failure decompensation requiring IV inotropic therapy. Sick sinus syndrome, including sino-atrial block; 2nd & 3rd degree heart block (w/o pacemaker); history of bronchospasm & bronchial asthma; untreated phaeochromocytoma; metabolic acidosis; bradycardia (heart rate <60 bpm prior to therapy); hypotension (systolic BP <90 mmHg); severe peripheral circulatory disturbances. Liver insufficiency or liver function impairment.

May increase sensitivity to allergens & severity of anaphylactic reactions. Observe caution w/ certain anaesth that cause myocardial depression. Should not be used in patients w/ untreated CHF. May induce bradycardia. Use w/ caution in patients w/ peripheral circulatory disorders (Raynaud's disease or syndrome, intermittent claudication); 1st degree heart block; Prinzmetal's angina; COPD; history of psoriasis. May mask certain symptoms of hypoglycaemia (tachycardia, palpitations) & tachycardic symptoms in hyperthyroidism. Concomitant use w/ Ca channel antagonist (eg, verapamil, diltiazem), class I antiarrhythmic drugs, & centrally-acting antihypertensive drugs is not recommended. Treatment discontinuation should be done gradually, unless clearly indicated. Rare hereditary problems of galactose intolerance, the Lapp-lactase deficiency or glucose-galactose malabsorption. Dizziness & fatigue may affect ability to drive & use machines. Pregnancy & lactation. Elderly >75 yr (for hypertensive patients). Childn & adolescents <18 yr.

Headache, dizziness, paraesthesia; dyspnoea; constipation, nausea, diarrhoea; tiredness, oedema.

Potentiated AV conduction time & increased negative inotropic effect w/ class I antiarrhythmics (quinidine, hydroquinidine, cibenzoline, flecainide, disopyramide, lidocaine, mexiletine, propafenone); class III antiarrhythmic drugs (amiodarone). Negative influence on contractility & AV conduction w/ Ca channel antagonists of verapamil/diltiazem type. Profound hypotension & AV block w/ IV verapamil. Worsened heart failure by a decrease in central sympathetic tones (reduction of heart rate & cardiac output, vasodilation) w/ centrally-acting antihypertensives (clonidine, guanfacine, moxonidine, methyldopa, rilmenidine). Attenuated reflex tachycardia & increased risk of hypotension w/ anaesth. Increased fall in BP w/ baclofen (antispastic agent), amifostine (antineoplastic adjunct). Increased AV conduction time w/ digitalis glycosides. Increased risk of hypotension, & further deterioration of ventricular pump function in patients w/ heart failure w/ Ca antagonists of the dihydropyridine type (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nitrendipine). Enhanced hypotensive effect w/ antipsychotics, antidepressants (TCAs, barbiturates & phenothiazines). Risk of HTN, severe bradycardia & heart block w/ sympathomimetic agents. Increased plasma levels w/ CYP2D6 inhibitors eg, paroxetine, fluoxetine, thioridazine & quinidine.

Beta-Blockers

C07AB12 - nebivolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

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