Bystolic side effects and how to avoid them

Bystolic can lower blood pressure and help reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and heart attacks

By Stephanie Melby, Pharm.D. | Nov. 15, 2021

Bystolic belongs to a class of medications called beta-blockers, preferentially beta-1 selective. These specific beta-1 blocking medications work on these receptors in the heart. Beta-blockers lower blood pressure in part by lowering the rate and force that the heart pumps blood. As with most blood pressure medications, Bystolic can have side effects. The most common Bystolic side effects are headache and fatigue.

Compared to other beta-blockers, the way Bystolic works in the body is unique. Along with blocking beta-1 receptors, Bystolic widens blood vessels (vasodilation) through nitric-oxide effects that act on beta-3 receptors. This additional effect makes Bystolic different and helps to promote blood flow. Bystolic is typically associated with a lower rate of side effects compared to other blood pressure lowering therapies. While Bystolic is a great option for some people, it may not be the best fit for others. This article is going to dive into possible side effects, warnings, and interactions for Bystolic.

RELATED: What is Bystolic?

Common side effects of Bystolic

Here are the most common side effects of nebivolol (Bystolic):

Headache
Fatigue
Dizziness
Diarrhea
Nausea

Bystolic and headache

The most common side effect of Bystolic is headache and will affect about 6 to 9% of people. However, this side effect was not bothersome enough for most people to stop taking Bystolic. In the manufacturer clinical trial, only 0.4% of people discontinued taking the medication due to headaches. And in general, only 2.8% of people stopped taking Bystolic due to side effects.

Many medication package inserts and patient information pamphlets list headaches as a common side effect. It’s important to note that medication use with headache does not mean there is a relationship, as headaches can be due to many other causes. People can treat these headaches by resting, using pain relievers, drinking plenty of fluids, and exercising. It’s important that people check their blood pressure with their monitor at home. If a person’s blood pressure is too low or too high, he or she could develop a headache.

Bystolic and fatigue

The second most common side effect of Bystolic is fatigue and will affect about 3 to 4% of people. Fatigue could happen because Bystolic can slow the heart rate. Other signs of slow heart rate that people may experience are dizziness, lightheadedness, tiredness, or lack of energy. Fatigue is often related to the dose of Bystolic, so typically people will only experience fatigue at higher doses. Since Bystolic can slow down the heart rate, it’s important people contact their doctor if they experience trouble breathing or increased shortness of breath and seek medical attention.

Serious side effects of Bystolic

The following are possible serious side effects of Bystolic:

- Bradycardia (slow heartbeat)
- Heart block (electrical signals in heart not working properly)
- Congestive heart failure (CHF)
- Acute renal (kidney) failure
- Bronchospasm (spasm in airways)
- Lupus erythematosus
- Raynaud phenomenon (decreased blood flow to fingers)
- Serious side effects if abruptly stopping Bystolic include:
  - Angina exacerbation (chest pain)
  - Myocardial infarction (heart attack)
  - Ventricular arrhythmia (abnormal heartbeat)

How long do side effects last?

In general, Bystolic is very well tolerated and side effects are uncommon. In the manufacturer clinical trial, it was determined that the discontinuation rate due to side effects among nebivolol treated patients was low (2.8%) versus the placebo treated patients (2.2%). The most common adverse effects that led to discontinuation of Bystolic were headache (0.4%), nausea (0.2%) and bradycardia (0.2%).

If any of these side effects continue after several weeks, are bothersome, or worsen over time, patients should contact their doctor to discuss treatment. If an allergic reaction is suspected, a doctor should be contacted immediately.

Bystolic contraindications & warnings

Abrupt withdrawal

Bystolic should not be immediately stopped in people with coronary artery disease. This is important so that these patients don’t develop angina (chest pain) exacerbation, heart attack, or irregular heartbeats. If Bystolic needs to be discontinued for any reason, a healthcare provider should be consulted to develop a careful plan. The Bystolic dose should be slowly lowered over one to two weeks if possible. If chest pain worsens or acute coronary syndrome develops, Bystolic should be restarted quickly, at least temporarily.

Overdose

It is possible to overdose on Bystolic if too much is taken. The two most common signs and symptoms of Bystolic overdose are bradycardia (slowed heartbeat) and low blood pressure. Some reports also include heart failure, dizziness, low blood sugar, fatigue, and vomiting. If an overdose is suspected, people should call 911 or visit an emergency medical facility.

Restrictions and Precautions

Avoid use in patients with severe bradycardia (slow heart rate).
Avoid use in patients with heart block greater than first degree.
Avoid use in patients with cardiogenic shock.
Avoid use in patients with decompensated heart failure.
Avoid use in sick sinus syndrome (unless a permanent pacemaker is in place)
Avoid use in those with severe liver impairment.
Avoid use in breastfeeding mothers since it is not known if Bystolic is found in breast milk.
Not approved for use in pediatric patients (don’t use in those less than 18 years of age)
Use with caution in pregnancy and only if the benefits outweigh the risks. When treatment of hypertension does require medication in pregnant women, other blood pressure lowering medications are preferred.
Use with caution in patients with bronchospastic disease (such as COPD, emphysema, or asthma)
Use with caution in patients with compensated heart failure
Use with caution in patients with diabetes as Bystolic can mask the signs and symptoms of hypoglycemia (low blood sugar)
Use with caution in patients with overactive thyroid as Bystolic can mask the signs and symptoms of hyperthyroidism
Use with caution in patients with peripheral vascular disease as Bystolic can provoke or aggravate symptoms of arterial insufficiency (slowed or stopped blood flow in arteries)
Dose adjustments are recommended for people with renal (kidney) or hepatic (liver) impairment

Bystolic interactions

Bystolic has several drug interactions that should be avoided to prevent dangerous side effects. The following are medications and medication classes that should be avoided:

Digoxin: The heart failure treatment and abnormal heartbeat medication, digoxin, can slow down the heart rate. It should not be taken with Bystolic, which can also slow the heart, as patients would be at risk for dangerously slow heartbeat.
Calcium channel blockers: These blood pressure/heart medications (such as verapamil and diltiazem) can negatively affect the way the heart works if taken with Bystolic. The heart medication disopyramide can also have this interaction if taken with Bystolic.
Beta blockers: Bystolic should not be used with other medications in the beta blocker class. Some examples include carvedilol, atenolol, and metoprolol.
Clonidine: The blood pressure and ADHD medication, clonidine, can cause negative effects on blood pressure if taken with Bystolic.
Cancer medications: The medications brigatinib and ceritinib can enhance the slowed heartbeat effects if taken with Bystolic.
Multiple sclerosis: The medications fingolimod, ponesimod, and siponimod can enhance the slowed heartbeat effects if taken with Bystolic.
Rivastigmine: The medication rivastigmine used for Alzheimer disease and Parkinson disease dementia can cause dangerously slowed heartbeat if taken with Bystolic.

How to avoid Bystolic side effects

When starting a new medication, it’s important to read the drug information provided with the prescription and talk with a pharmacist for medical advice about potential side effects.

1. Take Bystolic as directed

The dose of Bystolic is individualized to the needs of the patient, so there is not a standard treatment dose. For most people, the recommended starting dose is a 5 mg tablet by mouth once daily.

The dose can be taken with or without food. Some people will need their dose increased based on their blood pressure results. The Bystolic dose can be increased at two-week intervals up to 40 mg. Bystolic is available as a 2.5 mg, 5 mg, 10 mg, and 20 mg tablet.

If a dose is missed, it’s important to take the missed dose as soon as it’s remembered. However, if the time is close to the next dose, skip the missed dose and return to the normal dosing time. Do not take two doses at the same time or extra doses.

2. Do not abruptly stop taking Bystolic

If patients want to stop taking Bystolic because of side effects or poor results in blood pressure control, their doctors should be consulted. Abruptly stopping Bystolic can be dangerous, especially for those with coronary artery disease. People could develop withdrawal-like effects including chest pain, heart attack, or abnormal heartbeats. If Bystolic needs to be stopped, patients should work with their doctors to slowly reduce the dose over one to two weeks to discontinuation.

3. Tell the doctor about all medications being taken

Some medications can cause dangerous drug interactions if taken with Bystolic. Many medications can cause added slowing of the heartbeat when taken with Bystolic, like digoxin, other beta-blockers, and rivastigmine. It’s important that a healthcare professional is aware of all prescription drugs, over-the-counter medications, and supplements being taken by patients starting new medications.

4. Monitor blood pressure at home

People with high blood pressure should regularly take their blood pressure readings with an at-home monitor. It’s best to develop a plan with a healthcare team to establish how often blood pressure readings should be taken and the patient’s personal blood pressure goals. The American Heart Association has helpful tips and recommendations for taking blood pressure readings at home.

5. Tell the doctor about all medical conditions

To avoid potentially serious side effects with Bystolic, tell the prescribing healthcare provider about all medical conditions. This is especially important for patients with a history of COPD, asthma, heart failure, diabetes, hyperthyroidism, peripheral vascular disease, kidney disease, or liver disease. It’s important that a healthcare professional is aware of all medical conditions a patient has before starting new medications.

6. Manage side effects of headaches

While this side effect may be temporary, managing headaches can be done with over-the-counter medications and lifestyle modifications. Two common types of pain relievers available without a prescription are acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs). Tylenol may be the best option for headache relief in people with high blood pressure because NSAIDs can increase blood pressure. Always check with a doctor if uncertain about using over-the-counter pain relievers.

Additionally, people can make lifestyle changes to help manage headaches. People can make dietary modifications, try to get at least 7 to 8 hours of sleep, stay hydrated (6 to 8 glasses of water per day), exercise, and try relaxation therapy.

7. Monitor heart rate

People taking beta-blockers, like Bystolic, should regularly have their heart rate checked either at their doctor’s office or at home with a monitor or fitness tracker. It’s best to develop a plan with a healthcare team to establish how often heart rate readings should be taken and the patient’s personal heart rate goals. The American Heart Association has helpful tips and recommendations for monitoring heart rate.

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