Nebivolol

Nebivolol is used alone or in combination with other medications to treat high blood pressure. Nebivolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Nebivolol comes as a tablet to take by mouth. It is usually taken with or without food once a day. To help you remember to take nebivolol, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nebivolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of nebivolol and gradually increase your dose not more than once every 2 weeks. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Nebivolol controls high blood pressure but does not cure it. It may take 2 weeks before the full benefit of nebivolol is seen in blood pressure readings. Continue to take nebivolol even if you feel well. Do not stop taking nebivolol without talking to your doctor. If you suddenly stop taking nebivolol it may cause angina (chest pain), heart attack, or irregular heartbeat. Your doctor will probably decrease your dose gradually over 1 to 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking nebivolol,

• tell your doctor and pharmacist if you are allergic to nebivolol, any other medications, or any of the ingredients in nebivolol tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking nebivolol. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have a slow or irregular heart rate, liver disease, or heart failure. Your doctor may tell you not to take nebivolol.
• tell your doctor if you have or have ever had asthma or other lung diseases, diabetes, hyperthyroidism (an overactive thyroid gland), problems with blood circulation, kidney disease, or pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heart rate). Also tell your doctor if you have ever had a serious allergic reaction to a food or any other substance.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking nebivolol, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking nebivolol.
• you should know that nebivolol may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that nebivolol may increase the risk of hypoglycemia (low blood sugar) and prevent the warning signs and symptoms that would tell you that your blood sugar is low. Let your doctor know if you are unable to eat or drink normally or are vomiting while you are taking nebivolol. You should know the symptoms of low blood sugar and what to do if you have these symptoms.
• you should know that if you have allergic reactions to different substances, your reactions may be worse while you are using nebivolol, and your allergic reactions may not respond to the usual doses of injectable epinephrine.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Nebivolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• tiredness
• weakness
• dizziness
• diarrhea
• nausea
• stomach pain
• difficulty falling asleep or staying asleep
• numbness, burning, or tingling in the hands, arms, feet, or legs

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• chest pain
• slow heart rate
• difficulty breathing
• unusual weight gain
• shortness of breath
• rash; hives; swelling of the face, throat, tongue, lips, or eyes
• swelling of the hands, feet, ankles, or lower legs
• rapid, pounding, or irregular heartbeat
• vomiting

Nebivolol may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• slow heart rate
• dizziness or fainting
• shakiness
• sweating
• confusion
• nervousness, irritability, or sudden changes in behavior or mood
• headache
• numbness or tingling around the mouth
• weakness
• pale skin
• sudden hunger
• clumsy or jerky movements
• difficulty breathing or wheezing
• tiredness
• vomiting

Keep all appointments with your doctor. Your blood pressure should be checked regularly to determine your response to nebivolol. Your doctor may ask you to check your pulse (heart rate). Ask your pharmacist or doctor to teach you how to take your pulse. If your pulse is faster or slower than it should be, call your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking nebivolol.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Bystolic^®
• Vyduo^® (as a combination product containing Nebivolol, Valsartan)