nebivolol

Brand: Bystolic

⚠ BBW Prototype: metoprolol-succinate

Drug Class: beta-blocker

Drug Family: antihypertensive

Subclass: highly selective beta-1 blocker + NO-mediated vasodilation

Organ Systems: cardiovascular

Mechanism of Action

Third-generation cardioselective beta-1 blocker; enhances eNOS-mediated nitric oxide production causing vasodilation; reduces peripheral vascular resistance.

beta-1 adrenergic receptorendothelial nitric oxide synthase (eNOS)

Indications

hypertension

Contraindications

severe bradycardia
heart block > 1st degree
decompensated HF
cardiogenic shock
severe hepatic impairment

Adverse Effects

Common

headache
fatigue
dizziness
bradycardia

Serious

bronchospasm (rare)
heart block

Pharmacokinetics (ADME)

Absorption	26-96% (extensive CYP2D6 polymorphism)
Distribution	moderate
Metabolism	extensive hepatic CYP2D6
Excretion	renal 38%, fecal 44%
Half-life	12-19 hours (extensive metabolizers), 19-32h (poor)
Onset	1-4 hours
Peak	1.5-4 hours
Duration	24 hours
Protein Binding	98%
Vd	12 L/kg

Drug Interactions

Drug / Agent	Mechanism	Severity
CYP2D6 inhibitors	markedly increased nebivolol exposure	major
verapamil/diltiazem	additive AV block	major

Nursing Considerations

Third-generation beta-blocker with vasodilatory properties
Highly sensitive to CYP2D6 polymorphism — poor metabolizers have significantly higher exposure
Once-daily dosing
Monitor for bradycardia and hypotension

Clinical Pearls

Unique NO-mediated vasodilation differentiates from older beta-blockers
Metabolic neutrality: does not worsen insulin resistance or lipid profile
CYP2D6 poor metabolizers (7-10% of Caucasians) may require lower doses

Safety Profile

Pregnancy use-with-caution

Lactation avoid

Renal Adjustment Required

Hepatic Adjustment Required

TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Beta-blocker Hypertension

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