Nebivolol

May be taken with or without food.

Acute heart failure, cardiogenic shock or episodes of heart failure decompensation requiring IV inotropic therapy; sick sinus syndrome (including sinoatrial block), 2nd- or 3rd-degree heart block (without a pacemaker); history of bronchospasm and bronchial asthma; untreated phaeochromocytoma; severe bradycardia, hypotension (systolic blood pressure of <90 mmHg), severe peripheral circulatory disturbances; metabolic acidosis. Hepatic impairment.

Patient with peripheral circulatory disorders (e.g. Raynaud's disease, intermittent claudication), 1st-degree heart block, Prinzmetal's angina, diabetes mellitus, thyroid disease, history of psoriasis, COPD, history of severe anaphylaxis to a variety of allergens; myasthenia gravis. Patients undergoing surgery. Avoid abrupt withdrawal; chronic therapy must not be routinely withdrawn before major surgery. May mask the signs and symptoms of hypoglycaemia and hyperthyroidism (particularly tachycardia). Renal impairment; not recommended in severe renal impairment when used for chronic heart failure. Elderly. Pregnancy and lactation. Monitoring Parameters Monitor blood pressure and heart rate (before and during therapy and after any dose changes); serum glucose (in diabetic patients); renal and liver function. Obtain ECG.

Significant: Bradycardia. Cardiac disorders: Heart failure, slowed atrioventricular conduction, atrioventricular block. Eye disorders: Impaired vision. Gastrointestinal disorders: Nausea, diarrhoea, constipation, dyspepsia, flatulence, vomiting, abdominal discomfort. General disorders and administration site conditions: Fatigue, peripheral oedema. Nervous system disorders: Headache, dizziness, paraesthesia. Psychiatric disorders: Insomnia, nightmares, depression. Reproductive system and breast disorders: Impotence. Respiratory, thoracic and mediastinal disorders: Dyspnoea, bronchospasm. Skin and subcutaneous tissue disorders: Rash erythematous, pruritus. Very rarely, aggravated psoriasis. Vascular disorders: Hypotension, claudication.

Effect on atrioventricular conduction time may be potentiated and the negative inotropic effect increased with class I (e.g. quinidine, flecainide, lidocaine, disopyramide, mexiletine, propafenone, hydroquinidine, cibenzoline) and class III (e.g amiodarone) antiarrhythmics. May cause profound hypotension and atrioventricular block with IV verapamil . Concomitant use with Ca channel antagonists of verapamil or diltiazem type may have a negative influence on contractility and atrioventricular conduction. May worsen heart failure with centrally acting antihypertensives (e.g. clonidine, methyldopa, guanfacine, moxonidine, rilmenidine). May attenuate reflex tachycardia and increase the risk of hypotension with anaestheticsMay enhance the hypoglycaemic effects of antidiabetic agents. May increase atrioventricular conduction time with digitalis glycosides. Increase risks of hypotension with dihydropyridine Ca antagonists (e.g. amlodipine, nifedipine), amifostine, baclofen, TCAs, barbiturates, and phenothiazines. Increased plasma concentration associated with an increased risk of excessive bradycardia and adverse events with CYP2D6 inhibitors (e.g. fluoxetine, paroxetine, thioridazine, quinidine). Increased plasma concentration with cimetidine. May produce an excessive reduction of sympathetic activity with catecholamine-depleting drugs (e.g. reserpine, guanethidine).

Beta-Blockers

C07AB12 - nebivolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.