Bystolic® (Nebivolol)
Compared with: Blackmores Conceive Well Gold 28 Tablets + 28 Capsules

Bystolic (Nebivolol) is a once‑daily, highly β₁‑selective blocker with additional nitric‑oxide–mediated vasodilatory properties. At 5 mg daily, it reduces systolic and diastolic blood pressure effectively, improves endothelial function, and has a favorable side‑effect profile compared to traditional β‑blockers

Nebivolol Hydrochloride – available as 2.5 mg, 5 mg, 10 mg, and 20 mg tablets

Other Popular and Common Names
Nebivolol

Cardioselective β‑Blocker with NO‑Mediated Vasodilation

Bystolic® (brand)

NBLO (abbreviation)
β₁‑Adrenergic Blockade: High selectivity for cardiac β₁‑receptors reduces heart rate, myocardial contractility, and renin release.

Endothelial Nitric Oxide (NO) Release: Stimulates eNOS in vascular endothelium, increasing NO production and causing vasodilation, improved arterial flexibility, and reduced peripheral resistance
Essential Hypertension: Monotherapy or combined therapy for adults ≥18 years.

Heart Failure (Off‑Label): Limited data; primarily in specific patient subsets under specialist care.

Post‑MI Management: Secondary prevention of cardiovascular events in selected patients (off‑label).

Indication Initial Dose Titration Maximum Dose
Hypertension 5 mg once daily Increase in 2­-week intervals based on BP 40 mg once daily
Renal Impairment ≥CrCl 30 mL/min: none Hepatic Impairment Mild: no adjustment Moderate (Child‑Pugh B): start 2.5 mg Titrate cautiously
Severe (Child‑Pugh C): contraindicated

Administration: Swallow tablets whole with or without food, at the same time each day.
Medscape

Missed Dose: If within 12 hours of next dose, skip; otherwise, take when remembered.
Formulation: Film‑coated tablets

Strengths: 2.5 mg, 5 mg, 10 mg, 20 mg

Route: Oral

Legal Status: Prescription Only

Pregnancy: Category C – Use only if benefits outweigh risks; monitor fetal growth.

Breastfeeding: Excreted in breast milk; weigh benefits versus potential neonatal effects.

Pediatric Use: Not recommended in children <18 years.

Elderly: No initial dose adjustment; monitor for orthostatic hypotension and bradycardia.

Side‑Effects
Common (≥5 %)

Headache

Fatigue

Dizziness

Nausea

Bradycardia

Serious (rare)

Severe bradycardia

Heart block

Hypotension leading to syncope

Worsening heart failure

Erectile dysfunction

Warnings & Cautions
Contraindications:

Severe bradycardia (HR < 50 bpm)

Advanced heart block (unless paced)

Cardiogenic shock, decompensated heart failure

Sick sinus syndrome (without pacemaker)

Severe hepatic impairment (Child‑Pugh C)

Hypersensitivity to nebivolol
Abrupt Withdrawal: Taper gradually over 1–2 weeks to avoid rebound hypertension or angina.

Asthma/COPD: Use with caution—epi‑selectivity mitigates but does not eliminate bronchospasm risk.

Diabetes: May mask tachycardia from hypoglycemia; monitor blood glucose closely.

Renovascular Disease: Use cautiously in bilateral renal artery stenosis; monitor renal function.

Therapeutic Class: Antihypertensive

Pharmacologic Class: β₁‑Selective Adrenergic Blocker with NO‑Mediated Vasodilatory Activity

Legal Category: Prescription Only

Other β‑Blockers: Additive bradycardia—avoid concurrent use.

Non‑DHP CCBs (verapamil, diltiazem): Increased risk of AV block and bradycardia—monitor ECG.

CYP2D6 Inhibitors (e.g., fluoxetine, paroxetine): May increase nebivolol levels—monitor heart rate and blood pressure.

Alpha‑Blockers / Vasodilators: Additive hypotensive effects—start at lower doses and monitor blood pressure.

NSAIDs: May attenuate antihypertensive effect.

Clinical Evidence
Bystolic 7 Trial: Nebivolol 5 mg reduced systolic/diastolic BP by ~20/10 mm Hg versus placebo at 8 weeks, with low side‑effect incidence

MERIT‑HF Post‑Hoc Analysis: Improved endothelial function and arterial stiffness versus metoprolol in hypertensive cohorts
FAQs – Bystolic (Nebivolol)
Q1. When will I see blood-pressure reduction?
A: Onset within 1 hour; peak effect at 4 hours; full therapeutic effect by 2–4 weeks.

Q2. Can I take it with food?
A: Yes—food does not affect absorption.

Q3. How do I taper off?
A: Reduce dose by 50 % weekly over 1–2 weeks, then discontinue.

Q4. Does Bystolic improve endothelial function?
A: Yes—its NO‑mediated vasodilation enhances arterial flexibility.

Q5. Is Bystolic safe in COPD?
A: Use with caution; its β₁‑selectivity reduces but does not eliminate bronchospasm risk.

Q6. What monitoring is needed?
A: Check heart rate and blood pressure at baseline, after dose changes, and periodically.

Q7. Can Bystolic help with post‑MI outcomes?
A: Off‑label use in selected patients; consult cardiologist for individualized therapy.
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