Nebipres
Generic Name
Nebivolol
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nebipres 5 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Nebipres 5 mg Tablet is a medication used to treat high blood pressure (hypertension) and chronic heart failure. It belongs to a group of medicines called beta-blockers, which work by blocking the action of certain natural chemicals in the body, such as adrenaline, to slow down the heart rate and relax blood vessels, allowing blood to flow more easily.
Uses & Indications
Dosage
Adults
Hypertension: Initially 5 mg once daily. May be increased to 10 mg or 20 mg once daily if needed. Chronic Heart Failure: Initially 1.25 mg once daily, titrated up gradually over 1-2 weeks to a maximum of 10 mg once daily.
Elderly
No specific dose adjustment is required for patients over 65 years. For patients over 75 years with chronic heart failure, careful monitoring and slower titration are recommended.
Renal_impairment
Initial dose of 2.5 mg once daily for severe renal insufficiency (creatinine clearance <30 ml/min). Dose should be adjusted cautiously.
How to Take
Take the tablet orally with a glass of water, with or without food. It should be taken at the same time each day.
Mechanism of Action
Nebivolol is a highly selective beta-1 adrenergic receptor blocker. It lowers heart rate and cardiac output. Additionally, it causes vasodilation, primarily through an endothelium-derived nitric oxide (NO) mediated mechanism, which contributes to its antihypertensive effect. This dual mechanism helps in both blood pressure reduction and improving cardiac function.
Pharmacokinetics
Onset
Antihypertensive effect usually evident within 1-2 weeks; maximum effect may take 4 weeks.
Excretion
Approximately 38% in urine and 48% in feces.
Half life
Approximately 10 hours for extensive metabolizers and 30-50 hours for poor metabolizers.
Absorption
Rapidly absorbed after oral administration. Bioavailability averages 12% in extensive metabolizers and 96% in poor metabolizers (due to CYP2D6 polymorphism).
Metabolism
Extensively metabolized, primarily via hepatic hydroxylation (involving CYP2D6) and to a lesser extent, glucuronidation.
Side Effects
Contraindications
- •Hypersensitivity to nebivolol or any excipient
- •Hepatic insufficiency or 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 in history
- •Untreated pheochromocytoma
- •Metabolic acidosis
- •Severe peripheral arterial disease
- •Severe bradycardia (heart rate <60 bpm before starting treatment)
Drug Interactions
NSAIDs
May reduce the antihypertensive effect of nebivolol.
Digitalis glycosides
May increase AV conduction time.
Insulin and oral antidiabetics
May mask certain symptoms of hypoglycemia (e.g., tachycardia, palpitations).
Calcium antagonists (e.g., verapamil, diltiazem)
Negative influence on contractility and AV conduction. Do not administer nebivolol with verapamil IV.
Class I antiarrhythmics (e.g., disopyramide, quinidine)
May potentiate effect on atrioventricular conduction time and induce negative inotropic effect.
Tricyclic antidepressants, barbiturates, phenothiazines
May enhance the hypotensive effect of nebivolol.
CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, thioridazine)
May increase nebivolol plasma levels, leading to increased risk of side effects.
Centrally acting antihypertensives (e.g., clonidine, methyldopa)
Concurrent use may worsen heart failure. Sudden withdrawal of clonidine while on beta-blocker therapy may increase risk of 'rebound hypertension'.
Storage
Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include bradycardia, hypotension, bronchospasm, and acute cardiac insufficiency. Treatment should be supportive and symptomatic. Gastric lavage and activated charcoal may be considered. Atropine for bradycardia, IV fluids and vasopressors for hypotension, and bronchodilators for bronchospasm.
Pregnancy & Lactation
Pregnancy: Category C. Should not be used during pregnancy unless clearly necessary. Consult your doctor. Lactation: Nebivolol is excreted in breast milk. Breastfeeding is not recommended during treatment.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24-36 months from manufacturing date.
Availability
Available in pharmacies nationwide
Approval Status
Approved by national regulatory authorities (e.g., DGDA)
Patent Status
Generic available, original patent expired
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Global Brand Names
International brand names for this medicine
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