Nebivolol

Key facts

• Nebivolol (Bystolic) is a beta-blocker that slows the heart rate and relaxes blood vessels to lower blood pressure.
• You take it once daily at the same time each day, and it can take one to two weeks for the full blood-pressure-lowering effect to appear.
• Its single most important safety fact: never stop nebivolol suddenly. Abrupt withdrawal after regular use can cause rebound high blood pressure, chest pain, or a heart attack, so your prescriber will taper the dose gradually.
• Seek urgent care for a very slow heartbeat, fainting, or new shortness of breath.

What Nebivolol treats

Nebivolol treats high blood pressure, and in some countries it is also used for stable chronic heart failure with reduced pumping function in older adults. It lowers blood pressure and eases the heart's workload; it is not a treatment for sudden chest pain during a heart attack.

How Nebivolol works

Nebivolol blocks beta-1 receptors in the heart, slowing the heart rate and reducing the force of each contraction, so the heart pumps against less resistance. It also promotes the release of nitric oxide, which relaxes and widens blood vessels, adding a further blood-pressure-lowering effect not shared by older beta-blockers.

Before you take it

• Avoid nebivolol if you have a very slow heart rate, certain heart blocks without a pacemaker, severe uncontrolled heart failure, or severe asthma.
• Tell your prescriber if you have diabetes, since nebivolol can mask the fast heartbeat that normally warns of low blood sugar.
• Combining nebivolol with other blood-pressure medicines, certain heart-rhythm drugs, or excess alcohol can push your blood pressure or heart rate too low.
• If you need surgery, tell your anesthesiologist you take nebivolol. It is usually continued, not stopped, before an operation.

Side effects

Common effects include fatigue, dizziness, headache, cold hands or feet, and nausea.

Stop and seek urgent medical care for any of these:

• A heart rate that feels unusually slow, or fainting.
• Severe dizziness or lightheadedness.
• New or worsening shortness of breath, or swelling of the legs and ankles.
• Facial swelling or difficulty breathing.

Safety essentials

• Do not stop nebivolol abruptly, even if you feel well. Sudden withdrawal can provoke rebound high blood pressure, angina, or a heart attack, so any dose change must be gradual and supervised.
• If you have diabetes, monitor your blood sugar carefully, since nebivolol can hide the warning signs of hypoglycemia.
• Check your pulse if your prescriber advises it, and contact them if it falls below the rate they specify for you.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.