Nebipres-HZ
Generic Name
Nebivolol and Hydrochlorothiazide
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nebipres hz 5 mg tablet | ৳ 12.00 | ৳ 120.00 |
Description
Overview of the medicine
Nebipres-HZ is a fixed-dose combination medication used to treat essential hypertension. It combines nebivolol, a highly selective beta1-adrenergic receptor blocker, and hydrochlorothiazide, a thiazide diuretic, to effectively lower blood pressure.
Uses & Indications
Dosage
Adults
Usually one tablet (Nebivolol 5 mg/Hydrochlorothiazide 12.5 mg) once daily, taken at the same time each day.
Elderly
No specific dose adjustment is needed for elderly patients with normal renal function. Monitor renal function.
Renal_impairment
Not recommended for severe renal impairment (creatinine clearance <30 mL/min). Dose adjustment may be needed for moderate impairment.
How to Take
This medicine should be taken orally, with or without food, preferably at the same time each day.
Mechanism of Action
Nebivolol selectively blocks beta1-adrenergic receptors, leading to decreased heart rate, myocardial contractility, and renin release, alongside nitric oxide-mediated vasodilation. Hydrochlorothiazide inhibits sodium reabsorption in the distal convoluted tubule, increasing the excretion of sodium, chloride, and water, thereby reducing plasma volume and peripheral resistance.
Pharmacokinetics
Onset
Nebivolol: 1-2 hours; Hydrochlorothiazide: ~2 hours. Full effect may take 1-2 weeks.
Excretion
Nebivolol is excreted via urine (38%) and feces (48%). Hydrochlorothiazide is primarily excreted unchanged by the kidneys.
Half life
Nebivolol: ~10-12 hours (extensive metabolizers), 24-30 hours (poor metabolizers); Hydrochlorothiazide: 5.6-14.8 hours.
Absorption
Nebivolol is well absorbed (~12-96% bioavailability depending on metabolizer status). Hydrochlorothiazide is readily absorbed (65-75% bioavailability).
Metabolism
Nebivolol undergoes extensive hepatic metabolism, primarily via CYP2D6. Hydrochlorothiazide is not metabolized.
Side Effects
Contraindications
- Hypersensitivity to nebivolol, hydrochlorothiazide, or sulfonamide derivatives
- Severe bradycardia
- Sick sinus syndrome without a pacemaker
- Cardiogenic shock
- Decompensated heart failure
- Severe hepatic impairment
- Anuria, severe renal impairment (CrCl <30 mL/min)
- Refractory hypokalemia, hyponatremia, hypercalcemia
- Symptomatic hyperuricemia
- Acute myocardial infarction
- Severe peripheral arterial occlusive disease
Drug Interactions
NSAIDs
May reduce the antihypertensive effect of nebivolol and hydrochlorothiazide.
Digoxin
Increased risk of digitalis toxicity due to hydrochlorothiazide-induced hypokalemia.
Lithium
Renal clearance of lithium is reduced by thiazides, increasing lithium levels and toxicity.
Antiarrhythmics
Increased risk of bradycardia and AV block with other beta-blockers or calcium channel blockers.
Corticosteroids
Increased risk of hypokalemia.
Other Antihypertensives
Potentiates antihypertensive effects, may lead to excessive hypotension.
Insulin/Oral Hypoglycemics
Thiazides may decrease glucose tolerance, requiring adjustment of antidiabetic medication.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include severe bradycardia, hypotension, acute cardiac failure, bronchospasm, acute renal failure, lethargy. Treatment is symptomatic and supportive, including gastric lavage, activated charcoal, IV fluids, and vasopressors if needed.
Pregnancy & Lactation
Pregnancy Category C (Nebivolol), B (Hydrochlorothiazide). Nebipres-HZ is not recommended during pregnancy unless the potential benefit justifies the potential risk to the fetus. Avoid use during lactation as both components are excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to nebivolol, hydrochlorothiazide, or sulfonamide derivatives
- Severe bradycardia
- Sick sinus syndrome without a pacemaker
- Cardiogenic shock
- Decompensated heart failure
- Severe hepatic impairment
- Anuria, severe renal impairment (CrCl <30 mL/min)
- Refractory hypokalemia, hyponatremia, hypercalcemia
- Symptomatic hyperuricemia
- Acute myocardial infarction
- Severe peripheral arterial occlusive disease
Drug Interactions
NSAIDs
May reduce the antihypertensive effect of nebivolol and hydrochlorothiazide.
Digoxin
Increased risk of digitalis toxicity due to hydrochlorothiazide-induced hypokalemia.
Lithium
Renal clearance of lithium is reduced by thiazides, increasing lithium levels and toxicity.
Antiarrhythmics
Increased risk of bradycardia and AV block with other beta-blockers or calcium channel blockers.
Corticosteroids
Increased risk of hypokalemia.
Other Antihypertensives
Potentiates antihypertensive effects, may lead to excessive hypotension.
Insulin/Oral Hypoglycemics
Thiazides may decrease glucose tolerance, requiring adjustment of antidiabetic medication.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose may include severe bradycardia, hypotension, acute cardiac failure, bronchospasm, acute renal failure, lethargy. Treatment is symptomatic and supportive, including gastric lavage, activated charcoal, IV fluids, and vasopressors if needed.
Pregnancy & Lactation
Pregnancy Category C (Nebivolol), B (Hydrochlorothiazide). Nebipres-HZ is not recommended during pregnancy unless the potential benefit justifies the potential risk to the fetus. Avoid use during lactation as both components are excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months from manufacturing date.
Availability
Pharmacies, Hospitals
Approval Status
Approved by regulatory authorities
Patent Status
Off-patent
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of nebivolol/hydrochlorothiazide combinations for the treatment of essential hypertension.
Lab Monitoring
- Blood pressure
- Heart rate
- Serum electrolytes (potassium, sodium, calcium)
- Renal function (BUN, creatinine)
- Blood glucose
- Uric acid levels
Doctor Notes
- Educate patients about the importance of consistent medication adherence and lifestyle modifications.
- Monitor electrolytes, renal function, and blood pressure regularly, especially in elderly or renally impaired patients.
- Counsel patients on potential side effects like dizziness and fatigue, and advise caution with activities requiring alertness.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor.
- Do not stop taking the medicine suddenly without consulting your doctor, as it may worsen your condition.
- Monitor your blood pressure regularly and report any significant changes to your doctor.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. However, 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
This medicine may cause dizziness or fatigue, especially at the beginning of treatment. Exercise caution when driving or operating machinery until you know how it affects you.
Lifestyle Advice
- Adopt a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity as advised by your doctor.
- Limit alcohol consumption and avoid smoking for better blood pressure control.
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