Nebivolol belongs to the class of medications called selective beta-blockers. It is used alone or with diuretics (water pills) or angiotensin converting enzyme (ACE) inhibitors to treat mild to moderately high blood pressure. It is believed to decrease blood pressure by relaxing the muscles surrounding the blood vessels allowing blood to flow more easily, reduce the heart rate and reduce the production of chemicals in the kidney that are responsible for causing increased blood pressure.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended starting dose for adults is 5 mg taken once daily. It should be taken at approximately the same time each day. If a higher dose is needed, your doctor may have you increase the dose slowly up to a maximum of 20 mg taken once daily.

Nebivolol may be taken with or without food.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor.

If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

2.5 mg
Each light blue, triangle-shaped, biconvex, unscored tablet engraved with "FL" on one side and "2.5" on the other contains 2.5 mg of nebivolol. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, FD&C Blue No. 2 Lake, FD&C Yellow No. 6 Lake, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinized starch, polysorbate 80, and sodium lauryl sulfate.

5 mg
Each beige, triangle-shaped, biconvex, unscored tablet engraved with "FL" on one side and "5" on the other contains 5 mg of nebivolol. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, FD&C Blue No. 2 Lake, FD&C Yellow No. 6 Lake, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinized starch, polysorbate 80, and sodium lauryl sulfate.

10 mg
Each pinkish-purple, triangle-shaped, biconvex, unscored tablet engraved with "FL" on one side and "10" on the other contains 10 mg of nebivolol. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, D&C Red No. 27 Lake, FD&C Blue No. 2 Lake, FD&C Yellow No. 6 Lake, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinized starch, polysorbate 80, and sodium lauryl sulfate.

20 mg
Each light blue, triangle-shaped, biconvex, unscored tablet engraved with "FL" on one side and "20" on the other contains 20 mg of nebivolol. Nonmedicinal ingredients: colloidal silicon dioxide, croscarmellose sodium, D&C Red No. 27 Lake, FD&C Blue No. 2 Lake, FD&C Yellow No. 6 Lake, hypromellose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, pregelatinized starch, polysorbate 80, and sodium lauryl sulfate.

Do not use nebivolol if you:

• are allergic to nebivolol or any ingredients of the medication
• have a condition known as "sick sinus syndrome"
• have a very slow heart rate
• have worsening congestive heart failure
• have serious heart block (second- or third-degree AV block)
• have severe peripheral arterial disorders (blockage of blood flow to limbs of body)
• have cardiogenic shock
• have severely reduced liver function
• have galactose, glucose-galactose or lactose intolerance

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• cough
• diarrhea
• dizziness
• dry mouth
• fatigue
• headache
• joint or back pain
• nausea
• nasal congestion and throat irritation
• rash
• trouble sleeping
• vision changes

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• breathing difficulty
• decreased heart rate
• memory problems
• severe dizziness or fainting
• signs of heart problems (e.g., fast, irregular heartbeat or pulse, chest pain, difficulty breathing)
• swelling in legs or feet

Stop taking the medication and seek immediate medical attention if any of the following occur:

• chest pain
• signs of heart attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Breathing conditions: In general, people who have asthma and certain other breathing problems or chronic lung disease should use nebivolol cautiously, as it can also have the effect of causing breathing difficulty. Low doses of nebivolol may be taken with caution by those with asthma who do not respond to or cannot tolerate alternative treatment. If you have breathing problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. It may be necessary to monitor your blood glucose levels more often when you are taking this medication.

Diabetes: As with other medications in this family, nebivolol makes the signs of low blood sugar less noticeable. If you have diabetes and take insulin or other medications that affect blood glucose levels, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. It may be necessary to monitor your blood glucose levels more often when you are taking this medication.

Dizziness/reduced alertness: Nebivolol may cause dizziness or lightheadedness, affecting your ability to concentrate well enough to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Hyperthyroidism: Nebivolol can reduce the symptoms that occur when you have hyperthyroidism (high levels of thyroid hormones). It does not affect the thyroid gland, it only hides the symptoms of an over-active thyroid gland. Stopping the medication suddenly could worsen this condition.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Pheochromocytoma: This medication can worsen the symptoms of pheochromocytoma (a tumour of the adrenal gland). If you have a pheochromocytoma, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Severe allergies: If you have allergies severe enough to cause anaphylaxis (a severe allergic reaction where swelling of the face, lips, and throat make it difficult to breathe), you should talk to your doctor about what to do if you have an allergic reaction. Nebivolol may make it more difficult to treat your allergic reaction with epinephrine.

Stopping the medication: Nebivolol should not be stopped suddenly. There have been reports of severe worsening of angina and of heart attack or abnormal heart rhythms occurring in people with angina pectoris who have done this. If it is necessary to stop taking this medication, your doctor will advise you how to gradually reduce your dose, to reduce the risk of these effects.

Pregnancy: The safety of this medication during pregnancy has not been determined. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if nebivolol passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

There may be an interaction between nebivolol and any of the following:

• abiraterone
• acetylcholinesterase inhibitors (e.g., donepezil, galantamine, rivastigmine)
• aldesleukin
• aliskiren
• allergen extract (e.g., grass pollen, white birch)
• alpha/beta agonists (e.g., epinephrine, norepinephrine)
• alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin, terazosin)
• alpha agonists (e.g., clonidine, methyldopa)
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine, methamphetamine)
• angiotensin converting enzyme inhibitors (ACEIs; enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• antiarrhythmic medications (e.g., amiodarone, disopyramide, dronedarone, flecainide, lidocaine, propafenone, sotalol)
• anti-psychotics (e.g., chlorpromazine, clozapine, haloperidol, quetiapine)
• apomorphine
• barbiturates (e.g., butalbital, phenobarbital)
• beta 2 agonists (e.g., salbutamol, salmeterol, formoterol, terbutaline)
• other beta-adrenergic blockers (e.g., atenolol, propranolol, metoprolol)
• bethanechol
• brimonidine
• bromocriptine
• bupivacaine
• bupropion
• cabergoline
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• celecoxib
• cinacalcet
• clobazam
• cocaine
• conivaptan
• darifenacin
• dexmethylphenidate
• diabetes medications (e.g., acarbose, canagliflozin, , glyburide, insulin, linagliptin, lixisenatide, metformin, rosiglitazone)
• diazoxide
• digoxin
• dipyridamole
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• ergot alkaloids (e.g., ergotamine, dihydroergotamine)
• fentanyl
• guanfacine
• HIV protease inhibitors (e.g., atazanavir, darunavir, indinavir, ritonavir, saquinavir, tipranavir)
• ivabradine
• levodopa
• mefloquine
• methacholine
• methylphenidate
• minoxidil
• mirabegron
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasasgiline, selegiline, tranylcypromine)
• morphine
• nabilone
• nitrates (e.g., isosorbide dinitrate, isosorbide mononitrate, nitroglycerin)
• nonsteroidal anti-inflammatories (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
• obinutuzumab
• pentoxifylline
• phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pilocarpine
• prochlorperazine
• protein kinase inhibitors (e.g., ceritinib, crizotinib, imatinib, nilotinib, regorafenib)
• quinidine
• riociguat
• ropinirole
• rotigotine
• sacubitril
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• somatostatin-like medications (e.g., lanreotide, octreotide, pasireotide)
• sphingosine 1-phosphate receptor (S1P) receptor inhibitors (e.g., fingolimod, ponesimod, siponimod)
• terbinafine
• tizanidine
• theophyllines (e.g., aminophylline, oxtriphylline, theophylline)
• tretinoin
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.