Nebivolol should be used with care when myocardial depressants or inhibitors of AV conduction, eg, certain calcium antagonists (particularly of the phenylalkylamine [verapamil] and benzothiazepine [diltiazem] classes) or anti-arrhythmic agents eg, disopyramide are used concurrently.
Both digitalis glycosides and β-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.
Patients receiving catecholamine-depleting drugs eg, reserpine or guanethidine should be closely monitored.
In patients who are receiving nebivolol and clonidine, nebivolol should be discontinued for several days before the gradual tapering of clonidine.
CYP2D6 Inhibitors: Caution should be used when nebivolol is co-administered with CYP2D6 inhibitors (quinidine, propafenone, fluoxetine, paroxetine, etc).
Cimetidine: Cimetidine causes a 23% increase in the plasma levels of d-nebivolol.
Sildenafil: The co-administration of nebivolol and a sildenafil decreased AUC and Cmax of sildenafil by 21% and 23% respectively. The effect on the Cmax and AUC for d-nebivolol was also small (<20%).