Bystolic alternatives: What can I take instead of Bystolic?

Creator: SingleCare
Published: 2022-03-28T19:09:23-04:00

Bystolic doesn’t work for everyone. Toprol XL, Lotensin, Diovan, hydrochlorothiazide, and Norvasc are some Bystolic alternatives. Get the full list here.

By Chad Shaffer, MD | Mar. 28, 2022

Options for hypertension (high blood pressure or BP) treatment are extensive. Out of all the possibilities, Bystolic (brand name of nebivolol) may be your chosen antihypertensive drug—and for good reason. Bystolic is a member of the beta blocker class with selective beta receptor action, meaning it has less risk of causing bronchospasm (bronchial tube tightening) compared to other beta blockers. You may be prescribed a beta blocker due to a history of heart disease or myocardial infarction (MI or heart attack). Whatever the reason for taking Bystolic, you may now be considering a change. The possible side effects of Bystolic could be bothering you, or the thought of a better, more affordable option may be enticing. In fact, beta blockers like Bystolic are not a preferred first-line option for most people with hypertension anymore.

What can I take in place of Bystolic?

There are many medications available to treat hypertension. Bystolic alternatives include other types of beta blockers or other classes of antihypertensives such as angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blocker (ARBs), and diuretics. These prescription medications may be more effective for certain individuals due to their different indications, common side effects, and doses.

RELATED: Bystolic dosage guide

Compare Bystolic alternatives
Drug name	Uses	Side effects	Dosage	Coupons
Bystolic (nebivolol)	Hypertension	Dizziness, bradycardia (slow heartbeat), bronchospasm, electrical heart block, CHF, renal (kidney) impairment, lupus erythematosus, tiredness, lightheadedness	2.5-40 mg once daily	Bystolic coupons
Coreg (carvedilol)	Hypertension, congestive heart failure (CHF) with low ejection fraction (EF or heart squeeze), left ventricular dysfunction after MI	Dizziness, bradycardia, bronchospasm, electrical heart block, CHF, lupus erythematosus, hypotension (low blood pressure), shortness of breath or trouble breathing	3.125-25 mg twice daily	Coreg coupons
Toprol XL (metoprolol extended release)	Hypertension, angina (chest pain), CHF with low EF, migraine prevention (off-label)	Dizziness, bradycardia, bronchospasm, electrical heart block, CHF, lupus erythematosus, shortness of breath, depression	25-400 mg once daily	Toprol XL coupons
Zestril (lisinopril)	Hypertension, CHF with low EF, acute MI, migraine prevention (off-label)	Dizziness, hypotension, cough, renal impairment, headache, hyperkalemia (high levels of potassium), angioedema (swelling under the skin often in the face)	2.5-40 mg once daily	Zestril coupons
Lotensin (benazepril)	Hypertension, heart failure (off-label)	Dizziness, hypotension, cough, renal impairment, headache, hyperkalemia, angioedema	5-40 mg once or twice daily	Lotensin coupons
Hydrochlorothiazide (HCTZ)	Hypertension, peripheral edema (swelling)	Dizziness, hypotension, hypokalemia (low potassium), hyponatremia (low sodium), hypercalcemia (high calcium), hyperuricemia (high uric acid), sun sensitivity	12.5-50 mg once daily (higher doses up to 200 mg may be used for edema)	Hydrochlorothiazide coupons
Zestoretic (combination lisinopril/hydrochlorothiazide)	Hypertension	Dizziness, hypotension, cough, renal impairment, headache, hyperkalemia, angioedema, hypokalemia, hyponatremia, hypercalcemia, hyperuricemia, sun sensitivity	10 mg/12.5 mg, 20 mg/12.5 mg, or 20 mg/25 mg once daily	Zestoretic coupons
Cozaar (losartan)	Hypertension, diabetic nephropathy, stroke prevention, CHF with low EF (off-label)	Dizziness, hypotension, cough, renal impairment, hyperkalemia, angioedema	25-100 mg once daily	Cozaar coupons
Diovan (valsartan)	Hypertension, CHF with low EF, left ventricular dysfunction (reduced heart squeeze) after MI	Dizziness, hypotension, cough, renal impairment, headache, hyperkalemia, angioedema	80-320 mg once daily (or daily dose divided into two doses)	Diovan coupons
Avapro (irbesartan)	Hypertension, diabetic nephropathy	Dizziness, hypotension, cough, renal impairment, hyperkalemia, angioedema	75-150 mg once daily	Avapro coupons
Norvasc (amlodipine)	Hypertension, coronary artery disease (CAD)	Dizziness, hypotension, peripheral edema, palpitations, flushing, angina	2.5-10 mg once daily	Norvasc coupons
Lotrel (combination amlodipine/benazepril)	Hypertension	Dizziness, hypotension, cough, peripheral edema, palpitations, flushing, angina, renal impairment, headache, hyperkalemia, angioedema	2.5 mg/10 mg, 5 mg/10 mg, 5 mg/20 mg, 5 mg/40 mg, 10 mg/20 mg, or 10 mg/40 mg once daily	Lotrel coupons
Cardizem CD (diltiazem extended release)	Hypertension, angina	Dizziness, hypotension, peripheral edema, bradycardia, electrical heart block or rhythm abnormality	120-480 mg once daily	Cardizem CD coupons
Aldactone (spironolactone)	Hypertension, CHF with low EF, edema, primary hyperaldosteronism (excess aldosterone from adrenal glands), diuretic-induced hypokalemia (off-label), idiopathic hirsutism (unexplained excess hair growth, off-label), acne vulgaris (off-label)	Dizziness, renal impairment, hyperkalemia, breast pain, gynecomastia (male breast enlargement), menstrual irregularity, stomach irritation or ulcer	12.5-100 mg once daily for hypertension (or up to 200-400 mg daily for some indications)	Aldactone coupons
Hydralazine	Hypertension, CHF with low EF (off-label, given with isosorbide dinitrate)	Hypotension, headache, lupus erythematosus tachycardia (fast heart rate), angina, palpitations	10-50 mg four times daily (or up to 100 mg three times daily for CHF with low EF)	Hydralazine coupons
Cardura (doxazosin)	Hypertension, benign prostatic hypertrophy (BPH, enlarged prostate)	Dizziness, hypotension, headache, palpitations, edema, shortness of breath, blurred vision	1-16 mg once daily (or maximum of 8 mg for BPH)	Cardura coupons

Other alternatives to Bystolic

Top 5 Bystolic alternatives

1. Toprol XL (extended-release metoprolol)

The beta blocker class of antihypertensives include Toprol XL, Tenormin, Inderal LA, Coreg, Coreg CR, bisoprolol, and Trandate. Among the entire category, their tendency to lower heart rate and create withdrawal symptoms when stopped makes them a second-line option for hypertension in many instances. Exceptions in which they may be chosen first include individuals with a history of a heart attack. These folks might benefit from beta blocker use for blood pressure control. The heart rate-limiting effects can also be helpful for those with atrial fibrillation, an irregular heart rhythm.

Like Bystolic, Toprol XL and related alternatives are selective beta blockers that largely avoid the bronchospasm risk associated with other members of the drug class.

A reason to change to Toprol XL from Bystolic could be the additional Food and Drug Administration (FDA) indications for using Toprol XL. Unlike Bystolic, Toprol XL is also indicated for angina and CHF with a low EF, as well as being used off-label for migraine prevention. If you have any of these conditions, Toprol XL could be appealing to you.

2. Lotensin (benazepril)

Lotensin is one of the ACE inhibitors, similar to Vasotec, quinapril, Altace, fosinopril, perindopril, and captopril. The class is preferred over beta blockers like Bystolic for hypertension treatment in those with diabetes mellitus, and it is often a first-line choice for others as well.

Hypertension frequently requires more than one drug class to control it, so combination agents are commonplace in order to provide multiple treatment mechanisms in one pill. If you need to add another drug class to your regimen for hypertension, benazepril has multiple combination options, while nebivolol, the active ingredient in Bystolic, has none. Benazepril is manufactured in combination with HCTZ (Lotensin HCT) as well as with amlodipine (Lotrel).

3. Diovan (valsartan)

ARBs, a drug class that includes Diovan, Cozaar, Benicar, Avapro, and Atacand, share similar cardiovascular and renal benefits with ACE inhibitors. ARBs are another first-line option for blood pressure management, particularly for most people with diabetes mellitus. The ACE inhibitor and ARB classes do not have the heart rate-lowering effects of beta blockers, so if this is a problem for you with Bystolic, these classes may be a better fit.

Unlike nebivolol, valsartan has combination pill options, including with HCTZ (Diovan HCT), amlodipine (Exforge), and both HCTZ and amlodipine (Exforge HCT).

Choosing between an ARB like Diovan and an ACE inhibitor like Lotensin could come down to the ARB group’s much lower incidence of cough side effects, about 3%, compared to as much as 35% with ACE inhibitors.

4. Hydrochlorothiazide (HCTZ)

If you have problems with peripheral edema (swelling in the lower legs), HCTZ may be helpful. It is a thiazide diuretic, as is chlorthalidone. The diuretic action may help to eliminate fluid and alleviate the edema. On the contrary, Bystolic can be associated with swelling. The downside of diuretics is the potential for electrolytes disturbances like hypokalemia and hyponatremia. While HCTZ could avoid the heart rate-lowering effects of Bystolic, you must be aware of the need for blood tests to monitor electrolytes if taking HCTZ.

5. Norvasc (amlodipine)

Dihydropyridine calcium channel blockers, like Norvasc, avoid the bradycardia risk of beta blockers, like Bystolic, and non-dihydropyridine calcium channel blockers, like Cardizem CD and Calan SR. In addition, they have no adverse effects on potassium or renal function tests. Besides Norvasc, the dihydropyridine calcium channel blockers also include Nifedical XL, Felodipine XR, and isradipine. You should note that they all have the potential side effect of peripheral edema.

Natural alternatives to Bystolic

Prescription drugs are not the only treatment option for hypertension. Lifestyle changes might be helpful, either along with or instead of prescription or over-the-counter medications, if your healthcare professional approves.

Ask for advice on whether studies showing a blood pressure benefit of weight loss and exercise apply to you.
Salt restriction might also be recommended.
A more involved diet called the DASH diet may be of interest. The Dietary Approaches to Stop Hypertension clinical trial showed that a diet rich in fruits, vegetables, and low-fat dairy products and low in saturated and total fats was effective for lowering blood pressure. The flavonoid content of fruits and vegetables could help to explain the diet’s effect. Flavonoid-rich cocoa was associated with a small reduction in blood pressure in one study.
Blood pressure improvement has also been noted with potassium, magnesium, fish oil, fiber, protein, and folate in limited studies. Supplements often have little proof of efficacy and safety, and each carries its own risks. Likewise, cannabidiol (CBD) has drawn interest, but it has not shown proven effectiveness for hypertension at this point. Get the medical advice of your healthcare provider before trying a vitamin or supplement as possible drug interactions could occur.

How to switch to a Bystolic alternative

Bystolic has some distinct advantages over other categories of blood pressure medications. It is not for everyone, and in most instances of hypertension, Bystolic is not the first choice. Bystolic may not be suitable to take if you have diabetes, as it may hide symptoms of low blood sugar.

If you are experiencing serious side effects from Bystolic or if you are interested in finding an antihypertensive drug that has other benefits or FDA indications, you should have a conversation with your healthcare professional. A discussion about your alternatives could lead you to a new medicine or help you to understand why Bystolic is the right choice for you.

Cost may be another factor in deciding to switch from Bystolic. Without insurance, generic Bystolic may cost $170 per 30, 10 mg tablets. Fortunately, you can use a SingleCare prescription discount card to save nearly $150 on generic Bystolic and up to 80% on other blood pressure medications.