Nebivolol (Bystolic)

Should not be abruptly discontinued in patients with coronary artery disease, as sere exacerbation of angina, myocardial infarction, and ventricular arrhythmias have been reported following the abrupt discontinuation of therapy with beta blockers.

Should be tapered over 1 to 2 weeks when possible.

If the angina worsens or acute coronary insufficiency develops, the drug should be restarted promptly, at least temporarily.

In general, patients with bronchospastic diseases should not receive beta blockers.

Because beta blocker withdrawal has been associated with an increased risk of MI and chest pain, patients already on beta blockers should generally continue treatment throughout the perioperative period.

Should be avoided, as other beta blockers, in patients with bronchospasm.

Its use should be continued perioperatively, and patients should be monitored closely when anesthetic agents which depress myocardial function are used.

The withdrawal of beta blocker agents, as this drug is, prior to major surgery may impair the heart’s ability to respond to reflex adrenergic stimuli and increase the risks of general anesthesia and surgical procedures.

Its beta-blocking effects can be reversed by beta agonists, such as dobutamine or isoproterenol.

May mask some of the manifestations of hypoglycemia, particularly tachycardia.

Beta blockers such as this agent may mask clinical signs of hyperthyroidism, such as tachycardia, and withdrawal of beta blockers in these patients may be followed by an exacerbation of symptoms or may precipitate a thyroid storm.

Can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease.

In a placebo-controlled trial of patients over 70 years of age with chronic heart failure receiving a maximum dose of 10 mg per day for a median of 20 months, no worsening of heart failure was reported with nebivolol compared to placebo.

Caution should be used with co-administered CYP2D6 inhibitors such as quinidine, propafenone, fluoxetine, and paroxetine as doses may need to be reduced.

Renal clearance is decreased in patients with severe renal impairment.

With severe renal impairment (ClCr less than 30 mL/min) the recommended initial dose is 2.5 mg once daily; titrate up slowly if needed.

Metabolism is decreased in patients with moderate hepatic impairment.

Wiith moderate hepatic impairment, the recommended initial dose is 2.5 mg once daily.

Most common adverse events are: headache, fatigue, dizziness, diarrhea, nausea, insomnia, chest pain, bradycardia, dyspnea, rash, and peripheral edema.

The most common adverse events that lead to discontinuation of the drug: are headache (0.4%), nausea (0.2%), and bradycardia (0.2%).

Should not be used with other beta blockers, as concomitant use can increase the risk of bradycardia.

Can exacerbate the effects of myocardial depressants or inhibitors of AV conduction, such as certain calcium channel antagonists or antiarrhythmic agents.

Not recommended for pregnant or nursing females or in pediatric patients.

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