Nebivolol

Before taking nebivolol,

• tell your doctor and pharmacist if you are allergic to nebivolol, any other medications, or any of the ingredients in nebivolol tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); beta blockers such as acebutolol (Sectral), atenolol (Tenormin, in Tenoretic), betaxolol, bisoprolol (Zebeta, in Ziac), carvedilol (Coreg), labetalol, metoprolol (Lopressor, Toprol XL), nadolol (Corgard, in Corzide), pindolol, propranolol (Inderal, InnoPran XL, in Inderide), sotalol (Betapace, Betapace AF, Sorine), timolol; bupropion (Aplenzin, Forfivo XL, Wellbutrin, Zyban); calcium channel blockers such as diltiazem (Cardizem, Dilacor, others) and verapamil (Calan, Covera, Isoptin, Verelan, in Tarka); chlorpheniramine (antihistamine in allergy and cold medications); cimetidine; clomipramine (Anafranil); clonidine (Catapres, Kapvay, in Clorpres); digoxin (Lanoxin); disopyramide (Norpace); duloxetine (Cymbalta); fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax); haloperidol (Haldol); insulin; oral medications for diabetes; methadone (Dolophine, Methadose); paroxetine (Paxil); propafenone (Rythmol); quinidine; reserpine; ritonavir (Norvir, in Kaletra); and sildenafil (Revatio, Viagra). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have a slow heart rate, heart or liver disease, or heart failure. Your doctor may tell you not to take nebivolol.
• tell your doctor if you have or have ever had asthma or other lung diseases, diabetes, hyperthyroidism (an overactive thyroid gland), problems with blood circulation, kidney disease, severe allergies, or pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heart rate).
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking nebivolol, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking nebivolol.
• you should know that nebivolol may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that if you have allergic reactions to different substances, your reactions may be worse while you are using nebivolol, and your allergic reactions may not respond to the usual doses of injectable epinephrine.

Nebivolol is part of the drug class:

• Beta blocking agents, selective

Do not skip doses or stop taking nebivolol without first talking to your doctor. Stopping suddenly may make your condition worse or cause other serious heart problems such as severe chest pain or heart attack. You may need to use less and less before you stop the medication completely.

If you need surgery, tell the surgeon ahead of time that you are using nebivolol.

Nebivolol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Nebivolol is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

You should not take nebivolol if you are allergic to it, or if you have:

• severe liver disease; or

• a heart problem such as heart block, sick sinus syndrome, slow heart rate, or heart failure.

To make sure you can safely take nebivolol, tell your doctor if you have any of these other conditions:

• asthma, bronchitis, emphysema;

• liver or kidney disease;

• diabetes;

• a thyroid disorder;

• a history of allergies;

• problems with circulation (such as Raynaud's syndrome);

• pheochromocytoma (tumor of the adrenal gland); or

• if you have recently had a heart attack.

FDA pregnancy category C. It is not known whether nebivolol will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether nebivolol passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

It is very important that your doctor check your progress at regular visits to make sure nebivolol is working properly and to check for unwanted effects.

Do not interrupt or stop using nebivolol without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

nebivolol may cause changes in your blood sugar levels. Also, nebivolol may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using nebivolol. You may need to stop using nebivolol several days before having surgery.

Before you have any medical tests, tell the medical doctor in charge that you are taking nebivolol. The results of some tests may be affected by nebivolol.

nebivolol may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking nebivolol.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else's drugs.
• Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
• Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
• Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about nebivolol, please talk with your doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about nebivolol. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using nebivolol.

Review Date: October 4, 2017

• Antihypertensive
• Beta-Blocker, Beta-1 Selective

Mild impairment (Child-Pugh class A): There are no dosage adjustments provided in the manufacturer’s labeling; use caution.

Moderate impairment (Child-Pugh class B): Initial: 2.5 mg once daily; if initial response is inadequate, may increase cautiously

Severe impairment (Child-Pugh class C): Use is contraindicated.

CrCl less than 30 mL/min:
-Initial dose: 2.5 mg orally once a day; titrate slowly as needed.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.