Nebivolol dosage, forms, and strengths

The prescription drug nebivolol treats high blood pressure. Like all blood pressure medications, a doctor’s prescription is required. Nebivolol is a beta blocker that lowers blood pressure by slowing the heart rate and widening blood vessels. It’s usually not a doctor’s first choice to lower blood pressure unless there are other serious problems like heart disease. Available only as a tablet, nebivolol doses are taken once daily with or without food. 

Nebivolol forms and strengths

Nebivolol is available in both a generic and a brand-name version called Bystolic. Both are sold as tablets in four dosage strengths:

• Tablets: 2.5 milligrams (mg), 5 mg, 10 mg, 20 mg

Nebivolol dosage for adults

Healthcare providers primarily use nebivolol to treat hypertension. It’s not usually their first choice. They usually prescribe nebivolol as an antihypertensive when there are other cardiovascular issues. In some cases, nebivolol has been used off-label to prevent migraines. Nebivolol doses are taken once daily.

Nebivolol is not safe for everyone to take. Some people with serious or life-threatening heart conditions are never given nebivolol or any other similar drug called beta blockers. See the section “Who should not take nebivolol.”

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Nebivolol dosage for hypertension

Doctors use nebivolol to lower blood pressure in people diagnosed with hypertension (high blood pressure). As a beta blocker, nebivolol works by slowing down heartbeats. The slower heart rate brings down blood pressure. At the same time, nebivolol causes blood vessels to widen (vasodilation), also reducing blood pressure. 

Guidelines advise clinicians not to use nebivolol if the only problem is high blood pressure. Instead, beta blockers like nebivolol can be used as a blood pressure drug when a patient also has coronary artery disease or a history of myocardial infarction (heart attack). Prescribers most commonly add it to another antihypertensive agent like valsartan.

People prescribed nebivolol will take one dose daily.

• Standard nebivolol dosage for high blood pressure: 5–40 mg taken orally once per day

• Maximum nebivolol dosage for high blood pressure: 40 mg per day

Nebivolol dosage for children

The FDA has not approved nebivolol as safe or effective for children. 

Nebivolol dosage restrictions

Doses may need to be reduced for people with liver problems or kidney problems. 

Some people don’t metabolize nebivolol very well. Healthcare providers call these people “CYP2D6 poor metabolizers.” Normally, they require dosage reductions of other drugs, but not nebivolol. 

• Patients with renal impairment (kidney disease): 

  • Severe renal impairment (creatinine clearance less than 30 mL/min): starting dose 2.5 mg per day

  • Dialysis: not defined 

• Patients with hepatic impairment (liver disease): 

  • Mild to moderate hepatic impairment (Child-Pugh Class A or B): starting dose 2.5 mg per day

  • Severe hepatic impairment (Child-Pugh Class C): do not use

Nebivolol dosage for pets

Veterinarians use beta blockers in dogs and cats for heart or blood pressure problems, usually metoprolol or propranolol. There are no dosage or safety guidelines for the use of nebivolol in animals. A veterinarian can prescribe the drug but ask about other alternatives. 

How to take nebivolol

Taking nebivolol doses is relatively simple and straightforward. If you can’t swallow a tablet, talk to the doctor about possible alternatives.

• Follow all the prescriber’s directions. 

• The dose may need to change a few times at the beginning of treatment, so make sure you’re taking the appropriate dose.

• Please read the Patient Information sheet that comes with the medication.

• Take only one dose daily.

• The tablets can be taken with food or on an empty stomach.

• Swallow the tablet whole with a drink of water. 

• Please follow any diet prescribed or recommended by the health care team.

• Store nebivolol tablets at room temperature 

• Keep nebivolol tablets out of the reach of children.

Nebivolol dosage FAQs

How long does it take nebivolol to work?

In clinical trials, nebivolol reached its maximum plasma concentrations about one and a half to four hours after a dose was administered. It may take longer in some people who don’t efficiently metabolize the drug (“poor metabolizers”).

How long does nebivolol stay in your system?

With a half-life of 12 to 19 hours, nebivolol takes about three to five days to completely clear from the system. Its effects on blood pressure can last up to 48 hours after a dose is taken. 

What happens if I miss a dose of nebivolol?

Take a missed dose as soon as you remember it. Skip the forgotten dose if it’s almost time for the next dose. Take the next dose at its regular time. Do not take an extra dose to make up for a missed dose.

How long can you take nebivolol?

Nebivolol is a long-term treatment for high blood pressure. As long as it works and there are no intolerable side effects, it can be taken for months or years.

How do I stop taking nebivolol?

Do not stop taking nebivolol until talking to the prescriber. The sudden discontinuation of beta blockers in people with coronary artery disease could cause chest pain, abnormal heartbeats, or a heart attack. If the drug isn’t working or is causing too much discomfort, the only safe way to stop nebivolol is for the doctor to gradually reduce the dose over several weeks. Patients should be monitored when tapering off nebivolol therapy and should limit physical activity.

The only exception to this rule is if the drug causes serious problems, such as a severe allergic reaction or serious heart problems, such as heart failure, heart block, dangerously slow heartbeats (bradycardia), bronchospasm (airway closure), or blood vessel problems. In those cases, a doctor may immediately stop the drug.

If you can’t continue taking nebivolol, the prescriber may try another beta blocker or antihypertensive agent such as an ACE inhibitor, angiotensin-II receptor blocker (ARB), calcium channel blocker, alpha blocker, or diuretic. 

What is the maximum dosage for nebivolol?

The maximum daily dose of nebivolol is 40 mg.

Can you overdose on nebivolol?

Yes. A large overdose could cause serious problems, including low blood sugar (hypoglycemia), airway closure, heart block, and cardiac failure. Call a poison helpline or get immediate medical care if too much nebivolol is taken. Signs of a nebivolol overdose include low blood pressure, slow pulse, fatigue, dizziness, and vomiting.

What interacts with nebivolol?

To avoid potentially serious drug interactions, tell the prescribing healthcare provider about all the prescription drugs, over-the-counter medications, and supplements you take, particularly:

• Other beta blockers

• Blood pressure medications called calcium channel blockers, such as diltiazem or verapamil

• Any other blood pressure medication, particularly clonidine, reserpine, or guanfacine

• Digitalis medicines such as digoxin

• Drugs that affect heartbeats, such as disopyramide, quinidine, and propafenone

• The antidepressant drugs Paxil (paroxetine) and Prozac (fluoxetine)

What happens when you mix nebivolol and alcohol?

Alcohol does not interact with nebivolol. However, both nebivolol and alcohol lower blood pressure, so ask the prescriber about any limits on drinking alcohol.

Is it safe to take nebivolol during pregnancy?

Healthcare professionals don’t know for sure if it’s safe to take nebivolol during pregnancy. It may cause problems such as low blood pressure, slow pulse, and trouble breathing in a newborn when mothers take nebivolol in the last three months of pregnancy.

Is it safe to take nebivolol while breastfeeding?

There is no information about how safe it is to take nebivolol while breastfeeding. Prescribers don’t know if it’s present in breast milk or can affect a nursing infant. Ask the prescriber for medical advice.

Does nebivolol have side effects?

The most common side effects of nebivolol are low blood pressure (hypotension), headache, fatigue, and dizziness. Other possible but less common adverse effects include tiredness, slow heart rate, and leg swelling (edema).

Does nebivolol have serious side effects?

Though uncommon, nebivolol can cause serious side effects such as chest pain, slow heart rate, airway closure (bronchospasm), heart block, and severe allergic reactions. Get medical help if you experience chest pain, shortness of breath, trouble breathing, palpitations, confusion, excessive tiredness, fatigue, or swelling of your face, lips, mouth, or throat.

Who should not take nebivolol?

Nebivolol is never prescribed to people with a very slow heartbeat (severe bradycardia), moderate to severe heart block, cardiogenic shock, symptomatic and worsening heart failure, sick sinus syndrome in a person without a pacemaker, severe liver impairment, or known allergies to any of the ingredients in the drug. 

Some health conditions can cause problems, so make sure the prescriber knows your entire medical history, particularly: 

• Any recent heart attack

• Irregular heartbeats

• Chest pain (angina)

• Asthma

• Bronchitis

• Emphysema

• Liver problems

• Kidney problems

• Peripheral vascular disease

• Diabetes

• Overactive thyroid (hyperthyroidism)

• Adrenal gland cancer (pheochromocytoma)

• Medication allergies

Sources

• 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, Journal of the American Academy of Cardiology

• Bystolic drug summary, Prescriber’s Digital Reference (PDR)

• Bystolic nebivolol hydrochloride tablet prescribing information, DailyMed (NIH National Library of Medicine)

• Nebivolol, StatPearls

• Nebivolol hydrochloride tablet prescribing information, DailyMed (NIH National Library of Medicine)