Adults

For hypertension: 5 mg once daily, may be increased up to 40 mg. For chronic stable heart failure: Initial dose 1.25 mg once daily, titrated slowly to max 10 mg once daily. For 2.5 mg strength, it's often a starting or maintenance dose for heart failure.

Elderly

For patients over 70 years, initial dose for heart failure is 1.25 mg once daily, titrated cautiously. No specific dose adjustment for hypertension unless renal impairment.

Renal_impairment

For severe renal impairment (CrCl <30 mL/min), initial dose is 1.25 mg once daily and titration should be cautious, maximum dose 2.5 mg daily.

Onset

Blood pressure lowering effect starts within a few hours, full effect within 1-2 weeks.

Excretion

Approximately 38% excreted in urine and 48% in feces.

Half life

Plasma elimination half-life is about 10 hours for extensive metabolizers and 30-50 hours for poor metabolizers.

Absorption

Rapidly absorbed after oral administration; bioavailability is variable due to first-pass metabolism, affected by CYP2D6 polymorphism.

Metabolism

Extensively metabolized in the liver, primarily by CYP2D6, to active hydroxyl metabolites.

Clonidine

Risk of rebound hypertension if clonidine is withdrawn abruptly while on nebivolol.

Other Beta-blockers

Concurrent use may result in additive effects, increasing the risk of bradycardia and hypotension.

Antiarrhythmics (e.g., Quinidine, Amiodarone)

Potentiation of effects on cardiac conduction.

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 concentrations and effects.