Adults

For hypertension: Initially 5 mg once daily, may be increased to 10 mg after 1-2 weeks. For heart failure: Initially 1.25 mg once daily, titrated gradually to a maximum of 10 mg once daily based on tolerance.

Elderly

No initial dose adjustment is required for hypertension. For heart failure, follow standard heart failure dosage titration.

Renal_impairment

For hypertension: Initial dose 2.5 mg once daily for patients with severe renal impairment (CrCl < 30 mL/min). For heart failure: Special caution and close monitoring during titration.

Onset

Blood pressure lowering effect is seen within 24 hours; full effect typically within 1-2 weeks.

Excretion

Approximately 38% in urine and 48% in feces.

Half life

Approximately 10-12 hours (active enantiomer) in extensive metabolizers; up to 30-50 hours in poor metabolizers.

Absorption

Rapidly absorbed after oral administration. Bioavailability averages 12% in extensive metabolizers and 96% in poor metabolizers due to extensive first-pass metabolism.

Metabolism

Extensively metabolized by direct glucuronidation and hydroxylation, primarily via CYP2D6.

Clonidine

Risk of rebound hypertension if clonidine is withdrawn abruptly while taking nebivolol.

CYP2D6 inhibitors (e.g., fluoxetine, paroxetine)

May increase plasma levels of nebivolol.

Calcium channel blockers (e.g., verapamil, diltiazem)

Increased risk of hypotension and bradycardia.

Class I antiarrhythmics (e.g., disopyramide, quinidine)

Potentiate effects on atrio-ventricular conduction time and negative inotropic effect.