valsartan and nebivolol

C09DX05

Forms & Strengths

Valsartan/Nebivolol combination tablets are not a standard FDA-approved single-entity product; components are typically co-prescribed.
Valsartan available as: 40 mg, 80 mg, 160 mg, 320 mg tablets.
Nebivolol available as: 2.5 mg, 5 mg, 10 mg, 20 mg tablets.

Adult Dosing

Hypertension: Individualized titration based on component response.
Valsartan typical starting dose: 80 mg to 160 mg once daily; max 320 mg daily.
Nebivolol typical starting dose: 5 mg once daily; max 40 mg daily.
Heart Failure (Valsartan): Start 40 mg twice daily, titrate to target 160 mg twice daily as tolerated.

Pediatric Dosing

Safety and efficacy in pediatric patients have not been established for this combination.
Valsartan (Hypertension, pediatric 6-16 years): Initial 1.3 mg/kg once daily (up to 40 mg total); max 2.7 mg/kg (up to 160 mg) daily.

Indications

Treatment of hypertension, alone or with other antihypertensive agents, to lower blood pressure.
Reduction of cardiovascular mortality in clinically stable patients with left ventricular failure or left ventricular dysfunction following myocardial infarction (Valsartan component).

Mechanism of Action

Valsartan is an angiotensin II receptor blocker (ARB) that selectively blocks the AT1 receptor, preventing vasoconstriction and aldosterone secretion.
Nebivolol is a cardioselective beta-1 adrenergic receptor blocker with unique nitric oxide-mediated vasodilatory properties that reduce peripheral vascular resistance.

Contraindications

Hypersensitivity to valsartan, nebivolol, or any component of the formulations.
Concomitant use with aliskiren in patients with diabetes mellitus.
Severe hepatic impairment (Child-Pugh class C).
Bradycardia, second- or third-degree heart block, sick sinus syndrome (unless a permanent pacemaker is in place).
Cardiogenic shock or decompensated heart failure requiring inotropic therapy.
History of bronchospasm or severe asthma.

Adverse Reactions

Drug Interactions

Potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium: Increased risk of hyperkalemia with valsartan.
Lithium: Decreased renal clearance of lithium leading to potential toxicity.
CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): May increase plasma concentrations of nebivolol.
NSAIDs: May decrease the antihypertensive effect and increase risk of renal impairment.
Other antihypertensive agents and vasodilators: Enhanced hypotensive effect.
Negative inotropes or chronotropes (e.g., verapamil, diltiazem): Increased risk of bradycardia and heart block.

Curated Content: Needs Vetting Before Put to Clinical Use