Nebivolol is an oral prescription drug belongs to a class of medications called cardioselective beta1 receptor blocker with nitric oxide-potentiating vasodilatory effect. It is sold under the common brand name “Bystolic” used to treat hypertension and also for left ventricular failure.

Nebivolol work by preventing adrenaline (norepinephrine) from acting on beta-adrenoreceptors that are present in blood vessels and the heart. This causes blood vessels to relax and slow down the heart rate to improve blood flow, decrease blood pressure and reduce strain on the heart.

What is Nebivolol used for?


This drug is used to treat hypertension in adults either alone or in combination with other antihypertensive medications (such as thiazide diuretics). Lowering blood pressure helps to prevent strokes, heart attacks, and kidney problems.

How to use Nebivolol?

Take Nebivolol tablet orally with or without food, as directed by the doctor, usually, take twice a day. The dose of this drug depends on your medical condition and response to the treatment.

In case, if you miss a dose, take your dose as soon as you remember, avoid taking two doses at the same time. To help you remember to take this drug at the same time each day.

Carefully follow all the directions on your prescription label, and ask your doctor or pharmacist to explain any part you do not understand. Take nebivolol exactly as directed.

Your blood pressure or a heart condition may not be controlled if you alter your dose or miss your dose or use it more frequently than prescribed by your doctor

Use this medication regularly as instructed by your doctor to get the most benefit from it. It is essential to continue this drug even if you feel better. Many people with high blood pressure do not feel sick.

If you suddenly discontinue taking nebivolol, you may experience serious heart problems like heart attack and angina.

You may require at least two weeks to observe the full benefit of this medicine. Inform your doctor if your medical condition remains unchanged or if it worsens (for example, if your blood pressure continues to remains high, or you have worsening symptoms of heart failure like increased shortness of breath).

What are the side effects of Nebivolol?

The common side effects observed with the use of this drug include dizziness, tiredness, a slower heart rate, ddiarrhea nausea headache, If any of these effects remain or worsen, inform your doctor/pharmacist immediately.

Get up slowly from a sitting/lying position, as this may help to lessen the risk of dizziness and lightheadedness.

Nebivolol may decrease the flow of blood to your hands and feet, causing them to feel cold. Avoid smoking or chewing of tobacco as this may worsen this effect.

Get emergency medical assistance right away if you notice any of the following severe side effects, like blue fingers/toes, fainting, very slow heartbeat, new or worsening symptoms of heart failure (such as breathlessness, swelling ankles/feet, unusual tiredness, sudden weight gain), mental/mood changes (such as confusion, mood swings, depression).

A severe allergic reaction to this drug is very rare. However, symptoms of a severe allergic reaction such as rashes, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing may occur. Get emergency medical assistance immediately if you notice any of the above side effects.

This is not a complete record of all possible side effects. Inform your doctor at the earliest, if you notice any of the side effects that are not mentioned in this article.

See also Warning and Precautions sections.

What are the precautions while using Nebivolol?

Inform your doctor/pharmacist before taking nebivolol, if you are allergic to it; or if you have other allergies. This drug may also contain some inactive ingredients that can cause allergic reactions or other problems. Talk to your doctor/pharmacist for further information.

Inform your doctor/pharmacist about all the products you are using including prescription, non-prescription, vitamins, nutritional supplements, and herbal products.

Before taking nebivolol, notify your doctor or pharmacist your medical history, mainly of heart rhythm problems (like a slow heartbeat, second or third degree atrioventricular block), blood circulation problems (like Raynaud’s disease, peripheral vascular disease), breathing problems (like asthma, chronic bronchitis, emphysema), kidney disease, liver disease, mental/mood disorders (depression), muscle disease (myasthenia gravis), hyperthyroidism, severe allergic reactions.

Alcohol or marijuana can make you further dizzy or drowsy. Avoid alcoholic beverages. Discuss with your doctor if you are using marijuana.

This drug can make it difficult to control your blood sugar level. Monitor your blood sugar levels regularly share the results with the doctor. Notify your doctor quickly if you notice any symptoms of hyperglycemia (high blood sugar level) such as an increase in thirst or urination. Your doctor may recommend you exercises, diet or may adjust your diabetes medication.

If you have diabetes, nebivolol may mask the symptoms of hypoglycemia (sudden fall in blood sugar level) such as fast/pounding heartbeat you would usually feel when you are hypoglycemic. Other symptoms of hypoglycemia such as sweating and dizziness, does not change by this drug.

During pregnancy, nebivolol should be used only when benefits outweigh the risk. It may be harmful to the foetus. It is unknown whether this drug crosses into breast milk and for more information about the safety of drug talk to your doctor.

What are the drug interactions of Nebivolol?

Nebivolol may interact with other medications, herbs, or vitamins you may be using. A drug interaction is when a substance changes the way a drug works which can be harmful or hinder the drug from working well.

Do not start, stop, or alter the dose of the drug without discussing your doctor because your doctor may be monitoring you for possible drug interactions.

Taking heart rhythm drugs (quinidine, propafenone) along with nebivolol, increases the amount of this drug in your body. This increased amount of drug can lead to more side effects of nebivolol.

Nebivolol should not be used with other beta-blocker (acebutolol, atenolol, bisoprolol, metoprolol, propranolol) as this combination may further lower your heart rate and blood pressure.

Taking alpha-blockers (doxazosin, prazosin, terazosin) with nebivolol can cause an increased risk of low blood pressure when you stand (orthostatic hypotension). Orthostatic hypotension can cause dizziness and lightheadedness.

Taking catecholamine-depleting drugs (reserpine, guanethidine) along with nebivolol can significantly slow down your heart rate.

Taking clonidine along with nebivolol can further lower your blood pressure and heart rate. Your doctor closely monitors you if these drugs are used together or switching required from one drug to other.

NSAIDs (such as diclofenac, ibuprofen, indomethacin, ketorolac, nabumetone, naproxen), a nasal decongestant (such as phenylephrine, pseudoephedrine), cough-and-cold products, may decrease the effectiveness of nebivolol. Fingolimod may also interact with the drug.


Stopping the drug:

Do not suddenly discontinue this medication without informing your doctor. Some conditions may become dangerous when you suddenly stop this drug. In some people who have abruptly terminated taking similar drugs have had chest pain, heart attack, and even irregular heartbeat. If your doctor recommends you to stop this drug, your doctor may ask you to reduce your dose gradually.

When you gradually decrease the dose of this drug before discontinuing this medication, your doctor may recommend you to restrict physical activity to reduce pressure on your heart. Get medical emergency assistance immediately if you notice symptoms such as chest pain/tightness/pressure, unusual sweating, trouble in breathing, chest pain spreading to the jaw/neck/arm, or fast/irregular heartbeat.

Other conditions:

Before taking nebivolol, inform your doctor about all of your health conditions such as diabetes, chronic obstructive pulmonary disease (COPD), asthma, poor circulation, heart failure or other heart problems, hyperthyroidism.

What are the forms and strengths of Nebivolol?

Brand: Bystolic
Form: Oral tablet
Strengths: 2.5mg, 5mg, 10mg, 20mg

What is the dosage of Nebivolol?

For Hypertension (high blood pressure):

Adult (18 years and above):

Initial dose: Take 5mg once per day. Your dose will be adjusted at least two weeks apart based on your response to treatment.
Maximum dose: The maximum recommended dosage is 40mg once per day.

Children (0 to 17 years):

Avoid use of this drug in children below 18 years of age, as the studies have not been established yet.

Special Dosage Considerations:

Renal impairment: The recommended starting dosage for people with severe kidney disease is 2.5mg once per day. Your doctor will increase your dose slowly if needed.

Liver impairment: The recommended starting dosage for people with moderate liver disease is 2.5mg once per day. Your doctor will increase your dose slowly if needed.

Most commonly asked questions about Nebivolol / Q&A’s:

What are the symptoms of Nebivolol overdose?

Symptoms of nebivolol overdose may include slow heart rate, dizziness or fainting, shakiness, sweating, confusion, nervousness, numbness or tingling around the mouth irritability or sudden changes in behaviour or mood, headache, sudden hunger, weakness, pale skin, clumsy or jerky movements, difficulty breathing, seizures, tiredness, vomiting.


TheMedPharma has made every effort to make sure that all the information is factually correct, comprehensive, and up-to-date. However, this website should not be considered as a substitute for the advice, knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or licensed health care professional before taking any medication. The drug information contained herein is subjected to changes if required. The lack of warnings or other information for a given drug does not mean that the drug or its combination is safe, effective or appropriate for use in all patients.