Nebilol Plus
Generic Name
Nebivolol + Hydrochlorothiazide
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nebilol plus 5 mg tablet | ৳ 12.00 | ৳ 168.00 |
Description
Overview of the medicine
Nebilol Plus is a combination medicine containing Nebivolol, a beta-blocker, and Hydrochlorothiazide, a thiazide diuretic, used to treat essential hypertension.
Uses & Indications
Dosage
Adults
Usually one tablet (5 mg Nebivolol / 12.5 mg Hydrochlorothiazide) once daily. May be adjusted based on clinical response.
Elderly
Similar to adult dosage, but caution should be exercised and dose adjustment may be needed due to reduced renal function.
Renal_impairment
Use with caution. Not recommended if creatinine clearance is less than 30 mL/min.
How to Take
Take orally once daily, preferably at the same time each day, with or without food.
Mechanism of Action
Nebivolol is a cardioselective beta1-adrenergic receptor blocker with vasodilatory properties, lowering heart rate and blood pressure. Hydrochlorothiazide increases the excretion of sodium, chloride, and water, reducing blood volume and peripheral resistance.
Pharmacokinetics
Onset
Nebivolol: 1-2 hours. Hydrochlorothiazide: 2 hours.
Excretion
Nebivolol: Primarily via urine and feces as metabolites. Hydrochlorothiazide: Excreted unchanged in urine.
Half life
Nebivolol: 10-12 hours (extensive metabolizers), 30-50 hours (poor metabolizers). Hydrochlorothiazide: 5.6-14.8 hours.
Absorption
Nebivolol is rapidly absorbed after oral administration, with bioavailability around 12% (extensive first-pass metabolism). Hydrochlorothiazide is moderately absorbed, with bioavailability around 60-80%.
Metabolism
Nebivolol is extensively metabolized by glucuronidation and hydroxylation via CYP2D6. Hydrochlorothiazide is not metabolized.
Side Effects
Contraindications
- Hypersensitivity to nebivolol or hydrochlorothiazide
- Severe hepatic impairment
- Anuria
- Severe renal impairment (creatinine clearance <30 mL/min)
- Acute heart failure
- Cardiogenic shock
- Sick sinus syndrome (without a pacemaker)
- Second or third degree AV block (without a pacemaker)
- Severe bradycardia (<50 bpm)
- Uncontrolled heart failure
- Bronchial asthma
- Severe COPD
- Metabolic acidosis
- Untreated pheochromocytoma
- Peripheral arterial occlusive disease
Drug Interactions
NSAIDs
May reduce antihypertensive effect.
Lithium
Reduced renal clearance of lithium, leading to increased levels and toxicity.
Corticosteroids
Increased risk of hypokalemia.
Digitalis glycosides
Increased risk of bradycardia.
Antiarrhythmics (e.g., Amiodarone)
Increased risk of cardiac depression.
CYP2D6 inhibitors (e.g., Quinidine, Fluoxetine)
May increase nebivolol plasma levels.
Calcium channel blockers (e.g., Verapamil, Diltiazem)
May enhance hypotensive and bradycardic effects.
Storage
Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe bradycardia, hypotension, bronchospasm, and acute cardiac failure. Management involves symptomatic and supportive measures. Gastric lavage, activated charcoal, IV fluids, atropine, glucagon, and vasopressors may be used as needed.
Pregnancy & Lactation
Pregnancy Category C. Use only if potential benefit outweighs risk. Not recommended during lactation as both components are excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to nebivolol or hydrochlorothiazide
- Severe hepatic impairment
- Anuria
- Severe renal impairment (creatinine clearance <30 mL/min)
- Acute heart failure
- Cardiogenic shock
- Sick sinus syndrome (without a pacemaker)
- Second or third degree AV block (without a pacemaker)
- Severe bradycardia (<50 bpm)
- Uncontrolled heart failure
- Bronchial asthma
- Severe COPD
- Metabolic acidosis
- Untreated pheochromocytoma
- Peripheral arterial occlusive disease
Drug Interactions
NSAIDs
May reduce antihypertensive effect.
Lithium
Reduced renal clearance of lithium, leading to increased levels and toxicity.
Corticosteroids
Increased risk of hypokalemia.
Digitalis glycosides
Increased risk of bradycardia.
Antiarrhythmics (e.g., Amiodarone)
Increased risk of cardiac depression.
CYP2D6 inhibitors (e.g., Quinidine, Fluoxetine)
May increase nebivolol plasma levels.
Calcium channel blockers (e.g., Verapamil, Diltiazem)
May enhance hypotensive and bradycardic effects.
Storage
Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe bradycardia, hypotension, bronchospasm, and acute cardiac failure. Management involves symptomatic and supportive measures. Gastric lavage, activated charcoal, IV fluids, atropine, glucagon, and vasopressors may be used as needed.
Pregnancy & Lactation
Pregnancy Category C. Use only if potential benefit outweighs risk. Not recommended during lactation as both components are excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months
Availability
Pharmacies nationwide
Approval Status
Approved
Patent Status
Off-patent (for generic components)
Clinical Trials
Clinical trials have demonstrated the efficacy and safety of Nebivolol Plus in reducing blood pressure in patients with essential hypertension.
Lab Monitoring
- Blood pressure
- Heart rate
- Serum electrolytes (especially potassium)
- Renal function (BUN, creatinine)
- Blood glucose
- Lipid profile
Doctor Notes
- Monitor patients for signs of fluid and electrolyte imbalance, especially hypokalemia. Initiate with the lowest effective dose and titrate cautiously.
- Counsel patients on adherence and the importance of lifestyle modifications.
Patient Guidelines
- Take medicine regularly as prescribed.
- Do not stop taking the medicine abruptly.
- Monitor blood pressure regularly.
- Report any unusual symptoms to your doctor.
Missed Dose Advice
If a dose is missed, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
May cause dizziness or fatigue, especially at the start of treatment. Patients should be cautioned about driving or operating machinery until they know how they react to the medication.
Lifestyle Advice
- Maintain a healthy diet low in sodium.
- Engage in regular physical activity.
- Avoid smoking and excessive alcohol consumption.
- Manage stress effectively.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.