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CARDIOVASCULAR SYSTEM › BETA BLOCKING AGENTS › BETA BLOCKING AGENTS AND THIAZIDES › Beta blocking agents, selective, and thiazides
nebivolol and thiazides
C07BB12
Forms & Strengths
- Nebivolol 5 mg / Hydrochlorothiazide 12.5 mg oral tablet
- Nebivolol 5 mg / Hydrochlorothiazide 25 mg oral tablet
- Nebivolol 10 mg / Hydrochlorothiazide 12.5 mg oral tablet
- Nebivolol 10 mg / Hydrochlorothiazide 25 mg oral tablet
- Nebivolol 20 mg / Hydrochlorothiazide 12.5 mg oral tablet
- Nebivolol 20 mg / Hydrochlorothiazide 25 mg oral tablet
Adult Dosing
- Hypertension: One tablet daily, titrated based on clinical response.
- Maximum recommended dose: Nebivolol 20 mg / Hydrochlorothiazide 25 mg once daily.
- Renal impairment (CrCl < 30 mL/min): Thiazides generally ineffective; loop diuretics preferred.
- Hepatic impairment: Use with caution; initial titration should be conservative.
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established.
Indications
- Management of essential hypertension, typically as step-up therapy or when combination therapy is appropriate.
Mechanism of Action
- Nebivolol: Cardioselective beta-1 adrenergic receptor blocker with unique nitric oxide-mediated vasodilatory properties, decreasing heart rate, myocardial contractility, and sympathetic outflow.
- Hydrochlorothiazide: Thiazide diuretic that inhibits sodium and chloride reabsorption in the distal renal tubules, increasing excretion of sodium, water, potassium, and hydrogen ions, leading to reduced peripheral vascular resistance.
Contraindications
- Severe bradycardia
- Second- or third-degree heart block in the absence of a functioning pacemaker
- Cardiogenic shock
- Decompensated heart failure
- Sick sinus syndrome (unless permanent pacemaker in place)
- Severe hepatic impairment
- Anuria
- Hypersensitivity to nebivolol, thiazides, or sulfonamide-derived drugs
Adverse Reactions
- Headache
- Fatigue
- Dizziness
- Nausea
- Diarrhea
- Bradycardia
- Hypotension
- Hypokalemia
- Hyperuricemia
- Hyperglycemia
Drug Interactions
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) may increase nebivolol plasma concentrations.
- Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) increase risk of bradycardia and heart block.
- Lithium: Thiazide diuretics reduce renal clearance of lithium, increasing risk of lithium toxicity.
- NSAIDs may attenuate the antihypertensive and diuretic effects of thiazides.
- Antidiabetic agents: Thiazide-induced hyperglycemia may require dosage adjustment of antidiabetic drugs.
Curated Content: Needs Vetting Before Put to Clinical Use