Nebilol
Generic Name
Nebivolol
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nebilol 5 mg tablet | ৳ 8.06 | ৳ 112.84 |
Description
Overview of the medicine
Nebilol 5 mg Tablet is a medication used to treat high blood pressure (hypertension) and mild to moderate chronic heart failure. It belongs to a class of drugs called beta-blockers, which work by relaxing blood vessels and slowing heart rate to improve blood flow and lower blood pressure.
Uses & Indications
Dosage
Adults
Hypertension: 5 mg once daily. Max 10 mg/day. Chronic heart failure: Initially 1.25 mg once daily, titrated gradually up to a maximum of 10 mg once daily.
Elderly
Hypertension: Starting dose 5 mg once daily. Chronic heart failure: Initial dose of 1.25 mg once daily; dose titration should be gradual and individualised.
Renal_impairment
For severe renal impairment (CrCl < 30 mL/min), initial dose 2.5 mg once daily, if necessary, may be increased to 5 mg once daily. For moderate impairment (CrCl 30-80 mL/min), no dose adjustment usually needed, but monitor carefully.
How to Take
Take orally with or without food, at the same time each day.
Mechanism of Action
Nebivolol is a highly selective beta-1 adrenergic receptor antagonist. It selectively blocks beta-1 receptors in the heart, reducing heart rate and myocardial contractility. Additionally, it promotes vasodilation by enhancing nitric oxide release from endothelial cells, contributing to its blood pressure-lowering effect.
Pharmacokinetics
Onset
Blood pressure lowering effect usually seen within a few hours, full effect achieved within 1-2 weeks.
Excretion
Approximately 50% renally excreted and 50% fecally excreted, largely as metabolites.
Half life
Approximately 10-12 hours for nebivolol, but up to 24-27 hours for its active hydroxyl metabolites in poor metabolizers.
Absorption
Rapidly absorbed after oral administration; bioavailability is about 12% in extensive metabolizers and significantly higher in poor metabolizers.
Metabolism
Extensively metabolized in the liver, primarily via N-dealkylation and glucuronidation, and to a lesser extent by hydroxylation mediated by the CYP2D6 enzyme.
Side Effects
Contraindications
- Hypersensitivity to nebivolol or any excipients
- Liver dysfunction or hepatic impairment
- Acute heart failure, cardiogenic shock or episodes of decompensation requiring intravenous inotropic therapy
- Sick sinus syndrome, including sino-atrial block
- Second and third degree heart block (without a pacemaker)
- Bronchospasm and bronchial asthma history
- Untreated pheochromocytoma
- Metabolic acidosis
- Severe peripheral arterial occlusive disease
- Bradycardia (heart rate < 60 bpm prior to treatment)
Drug Interactions
Digitalis glycosides
Increased risk of bradycardia.
Antiarrhythmics (e.g., class I and III)
Increased risk of cardiac depression.
Calcium channel blockers (e.g., verapamil, diltiazem)
Increased risk of bradycardia and AV block.
CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine)
May increase nebivolol plasma levels, leading to increased beta-blocking effects.
Other antihypertensive agents (e.g., ACE inhibitors, ARBs, diuretics)
May potentiate the hypotensive effects.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include bradycardia, hypotension, bronchospasm, and acute cardiac insufficiency. Management involves symptomatic and supportive treatment, including atropine for bradycardia, vasopressors for hypotension, and bronchodilators for bronchospasm.
Pregnancy & Lactation
Pregnancy Category C. Should only be used if the potential benefit justifies the potential risk to the fetus. Nebivolol is excreted in breast milk; therefore, it is not recommended during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Usually 24 to 36 months from the date of manufacture.
Availability
Available in pharmacies worldwide
Approval Status
Approved in many countries including US, EU, and Bangladesh
Patent Status
Generic versions available
Clinical Trials
Nebivolol has been extensively studied in clinical trials for hypertension and chronic heart failure, demonstrating efficacy and safety profile. Key trials include those evaluating its effects on mortality and morbidity in elderly patients with heart failure.
Lab Monitoring
- Regular monitoring of blood pressure and heart rate is recommended. In patients with chronic heart failure, monitoring of renal function and electrolytes may be appropriate.
Doctor Notes
- Consider nebivolol's vasodilatory effects beneficial in hypertensive patients with endothelial dysfunction.
- Careful titration is crucial, especially in elderly patients and those with heart failure, starting with low doses.
- Monitor for bradycardia and hypotension, especially when co-administering with other cardiac medications.
Patient Guidelines
- Do not stop taking Nebilol abruptly without consulting your doctor.
- Take your medication at the same time each day to maintain a consistent effect.
- Inform your doctor about all other medications, supplements, and herbal products you are taking.
- Report any new or worsening symptoms to your doctor immediately.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
May cause dizziness or fatigue, especially at the start of treatment or after dose changes. Patients should be warned about driving or operating machinery until they know how Nebilol affects them.
Lifestyle Advice
- Adopt a healthy lifestyle including a balanced diet, regular exercise, limiting sodium intake, and avoiding smoking and excessive alcohol consumption to help manage blood pressure.
- Regularly monitor your blood pressure at home if advised by your doctor.
Alternative Medicines in Bangladesh
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.