Nebil Special Precautions

Anesthesia: Continuation of β-blockade reduces the risk of arrhythmia during induction and intubation. If β-blockade is interrupted in preparation for surgery, the β-adrenergic antagonist should be discontinued at least 24 hrs beforehand.
Caution should be observed with certain anesthetics that cause myocardial depression. The patient can be protected against vagal reactions by intravenous administration of atropine.
Cardiac Failure: In patients who have compensated CHF, nebivolol should be administered cautiously. If heart failure worsens, discontinuation of nebivolol should be considered.
Metabolic/Endocrinological: Care should be taken in diabetic patients, however, as nebivolol may mask certain symptoms of hypoglycemia (tachycardia, palpitations). Beta-adrenergic blocking agents may mask tachycardia symptoms in hyperthyroidism. Abrupt withdrawal may intensify symptoms.
Abrupt Cessation of Therapy: The treatment with nebivolol is not recommended to be stopped abruptly since this might lead to a transitory worsening of heart failure. If discontinuation is necessary, the dose should be gradually decreased, divided into halves weekly. If the angina worsens or acute coronary insufficiency develops, it is recommended that nebivolol be promptly reinstituted, at least temporarily.
Peripheral Vascular Diseases: β-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular diseases. Caution should be exercised in these patients.
Renal Insufficiency: Nebivolol should be used with caution in patients on dialysis.
Geriatric Patients: In patients >75 years, caution must be exercised and these patients should be monitored closely.
Others: Patients with a history of psoriasis should take β-adrenergic antagonists only after careful consideration. β-adrenergic antagonists may increase the sensitivity to allergens and the severity of anaphylactic reactions.
Patients with rare hereditary problems of galactose intolerance, Lapp-lactase deficiency or glucose-galactose malabsorption should not take Nebil.
Use in pregnancy: Nebivolol should be used during pregnancy (Category C) only if the potential benefit justifies the potential risk to the fetus. If treatment with nebivolol is considered necessary, the uteroplacental blood flow and the fetal growth should be monitored. In case of harmful effects on pregnancy or the fetus, alternative treatment should be considered. The newborn must be closely monitored. Symptoms of hypoglycemia and bradycardia are generally to be expected within the first 3 days.
Use in lactation: It is not known whether the drug is excreted in human milk. Because of the potential for β-blockers to produce serious adverse reactions in nursing infants, especially bradycardia, nebivolol is not recommended during nursing.