Common use of Bystolic (nebivolol)
Bystolic is indicated for the management of hypertension in adults. As a beta‑1 selective beta‑blocker, it lowers blood pressure by reducing heart rate and cardiac workload, and by enhancing nitric oxide–mediated vasodilation in the vascular endothelium. This dual action can lead to effective blood pressure reduction with a favorable side‑effect profile compared with some older beta‑blockers.
Lowering blood pressure reduces the risk of stroke, heart attack, heart failure, and kidney complications over time. Bystolic may be used as monotherapy or combined with other antihypertensives such as thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers. Choice of therapy is individualized based on blood pressure goals, comorbidities, and medication tolerability.
Although beta‑blockers as a class are used for additional cardiovascular indications, in the United States Bystolic is primarily approved for hypertension. Any off‑label use should be directed by a clinician who can weigh risks and benefits for your specific condition.
Dosage and direction
Typical starting dosage for adults with hypertension is 5 mg orally once daily, with or without food. Based on blood pressure response and tolerability, the dose may be titrated at intervals of about 2 weeks. Common maintenance doses are 5–10 mg once daily, with a maximum recommended dose of 40 mg once daily. Take Bystolic at the same time each day to keep levels steady.
Special populations may require adjusted dosing. In severe renal impairment (creatinine clearance less than 30 mL/min) or moderate hepatic impairment, clinicians often start at 2.5 mg once daily and titrate cautiously. Severe hepatic impairment is generally a contraindication. Older adults may also benefit from a lower starting dose with careful monitoring.
Do not abruptly discontinue Bystolic, especially if you have coronary artery disease. Sudden withdrawal can cause rebound tachycardia, increased blood pressure, or ischemia. If discontinuation is necessary, your clinician will typically taper the dose over 1–2 weeks while monitoring symptoms.
Bystolic tablets should be swallowed whole with water. If you are also taking other blood pressure medications, your clinician will guide how to combine them and the best timing to minimize side effects like dizziness or lightheadedness.
Precautions
Cardiac conduction abnormalities: Bystolic can worsen bradycardia and heart block. Use with caution in patients with first‑degree AV block and avoid in higher‑degree blocks unless a functioning pacemaker is present. Report symptoms such as fainting, dizziness, or marked fatigue.
Heart failure: In acutely decompensated heart failure, beta‑blockers may be harmful. Stable, chronic heart failure requires individualized decisions by a cardiologist. If started or continued, dosing changes should be cautious, with close monitoring for dyspnea, edema, or weight gain.
Respiratory disease: Although nebivolol is beta‑1 selective, high doses or sensitivity can still affect beta‑2 receptors, potentially provoking bronchospasm. Use caution in asthma, COPD, or reactive airway disease, and seek medical advice promptly if wheezing or shortness of breath worsens.
Diabetes and thyroid disease: Beta‑blockers can mask symptoms of hypoglycemia (such as tremor and palpitations) and hyperthyroidism (such as tachycardia). Monitor glucose closely if diabetic and watch for other signs of low blood sugar like sweating or confusion. Abrupt withdrawal in hyperthyroidism may precipitate thyroid storm—never stop suddenly.
Peripheral vascular disease and Raynaud’s: Beta‑blockers may exacerbate symptoms such as cold extremities or claudication in susceptible individuals. Discuss risks if you have severe peripheral artery disease.
Pregnancy and lactation: Beta‑blockers can reduce placental perfusion and may be associated with fetal growth restriction or neonatal bradycardia. Use only if the potential benefit justifies the risk. Limited data exist for nebivolol during breastfeeding; consider alternatives with more lactation safety data, or monitor the infant for bradycardia and poor feeding.
Surgery and anesthesia: Inform your surgical team you are taking Bystolic. Beta‑blockers are often continued perioperatively, but decisions are individualized. Certain anesthetics can potentiate bradycardia and hypotension.
Contraindications
Bystolic is contraindicated in patients with severe bradycardia; greater than first‑degree heart block (unless a pacemaker is in place); sick sinus syndrome (unless paced); cardiogenic shock; decompensated heart failure requiring inotropic therapy; severe hepatic impairment; and in those with known hypersensitivity to nebivolol or any component of the formulation.
Discuss your full medical history—including prior heart rhythm issues, liver disease, and any episodes of severe low blood pressure—with your clinician before starting nebivolol. A careful baseline assessment helps reduce the risk of serious adverse events.
Possible side effects
Common side effects include headache, fatigue, dizziness, nausea, and sometimes insomnia. Because Bystolic slows heart rate, mild bradycardia can occur. Many effects are transient during the first weeks as your body adjusts, but persistent or bothersome symptoms warrant medical review.
Less common effects may include diarrhea or constipation, peripheral edema, paresthesia (tingling), dyspnea, or rash. Sexual dysfunction has been reported with beta‑blockers, though nebivolol’s nitric oxide–mediated vasodilation may be associated with a lower incidence compared with some older agents.
Serious adverse effects are uncommon but require urgent care: severe bradycardia or syncope, new or worsening shortness of breath, chest pain, signs of heart block (extreme fatigue, confusion, near‑fainting), or allergic reactions such as facial swelling, hives, or difficulty breathing.
If you experience mood changes or depressive symptoms, speak with your clinician; beta‑blockers have been associated with mood effects in some patients, though causation is not firmly established for nebivolol.
Drug interactions
CYP2D6 inhibitors: Nebivolol is metabolized by CYP2D6. Potent inhibitors can increase nebivolol levels and enhance bradycardia or hypotension risk. Notable examples include paroxetine, fluoxetine, quinidine, bupropion, and terbinafine. Dose adjustments and closer monitoring may be necessary when co‑administered.
Other heart‑rate‑lowering drugs: Combining Bystolic with non‑dihydropyridine calcium channel blockers (verapamil or diltiazem), digoxin, ivabradine, or amiodarone can increase the risk of significant bradycardia or AV block. If combination therapy is clinically indicated, careful ECG and symptom monitoring is essential.
Antihypertensive agents and PDE5 inhibitors: Additive blood pressure‑lowering effects may occur with ACE inhibitors, ARBs, diuretics, alpha‑blockers, centrally acting agents (like clonidine), or phosphodiesterase‑5 inhibitors (sildenafil, tadalafil). Rise slowly from sitting or lying positions and watch for dizziness or fainting. When clonidine is used, taper the beta‑blocker first, then clonidine, to reduce rebound hypertension risk.
Respiratory medications: Beta‑agonist bronchodilators (albuterol, formoterol) may be less effective in the presence of beta‑blockers. If you have asthma or COPD, your clinician will balance respiratory control with blood pressure goals and may choose the lowest effective nebivolol dose.
Glucose‑modulating agents: Insulins and sulfonylureas can cause hypoglycemia whose adrenergic warning signs (e.g., palpitations, tremor) may be blunted by beta‑blockers. Increase frequency of blood glucose monitoring when starting or adjusting Bystolic.
NSAIDs and other considerations: Nonsteroidal anti‑inflammatory drugs may attenuate antihypertensive effects in some patients. Anesthetic agents and alcohol can enhance hypotension. Always provide a full medication and supplement list to your clinician and pharmacist to check for interactions.
Missed dose
If you miss a dose of Bystolic, take it as soon as you remember on the same day. If it is near the time of your next dose, skip the missed dose and resume your regular schedule. Do not double up to catch up, as this may increase the risk of bradycardia or hypotension.
Overdose
Overdose symptoms may include profound bradycardia, severe hypotension, dizziness or fainting, heart block, acute heart failure, bronchospasm, and in some cases hypoglycemia. This is a medical emergency. Call emergency services or go to the nearest emergency department immediately.
Management in a clinical setting may involve IV fluids, atropine for bradycardia, glucagon to bypass beta‑receptor blockade, vasopressors for hypotension, high‑dose beta‑agonists for bronchospasm, and temporary pacing if needed. Bring the medication bottle to the hospital if possible to assist the care team.
Storage
Store Bystolic tablets at room temperature (68–77°F or 20–25°C), in a dry place away from moisture and heat. Keep the bottle tightly closed and out of reach of children and pets. Do not use tablets past the expiration date, and dispose of unused medication according to pharmacist guidance or local take‑back programs.
U.S. Sale and Prescription Policy
In the United States, Bystolic (nebivolol) is a prescription‑only medication. It is not legal to purchase Bystolic without a valid prescription issued by a licensed clinician. This requirement protects patient safety by ensuring that dosing, monitoring, and potential interactions are evaluated within your medical context.
HealthSouth Hospital of Altamonte Springs offers a legal and structured solution for access by connecting patients to compliant telehealth evaluations. Through this pathway, licensed clinicians review your health history, current medications, and blood pressure goals. When clinically appropriate, they can issue a prescription that HealthSouth Hospital of Altamonte Springs can fill and ship, consistent with all federal and state regulations.
This streamlined, fully compliant process maintains the medical oversight essential for safe use of Bystolic while offering the convenience of online care. Availability may vary by state based on licensure and telehealth laws; verification of identity and, when indicated, recent blood pressure readings or labs may be requested. Always avoid websites promising Bystolic without a prescription—such offers are unsafe and unlawful.
