A cardioselective beta-blocker
Nebivolol
A heart-selective beta-blocker with some blood-vessel-relaxing action, used for high blood pressure and heart failure — particularly in older adults.
What is Nebivolol?
Nebivolol is a cardioselective (heart-selective) beta-blocker that acts mainly on the heart. It is used to treat high blood pressure and, in older adults, stable heart failure, by slowing the heart and easing the work it has to do.
Education and reference only. This is a plain-language guide to Nebivolol — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Nebivolol is a cardioselective ("heart-selective") beta-blocker, meaning it acts mainly on the heart with relatively less effect elsewhere in the body. It is used for high blood pressure and for heart failure, and is often a useful choice in older adults. A distinctive feature is that, alongside its beta-blocking action, it helps relax blood vessels, which adds to its blood-pressure-lowering effect. In the UK it is sold as Nebilet; in the US the equivalent brand is Bystolic. It is taken as a long-term, once-daily tablet.
How it works
Nebivolol blocks beta receptors on the heart that the stress hormones adrenaline and noradrenaline act on, which slows the heart rate and reduces the force of each beat, lowering the heart's workload and blood pressure. It is relatively selective for the heart, so it tends to have less effect on the airways and circulation than older, non-selective beta-blockers. It also promotes the release of nitric oxide, a natural substance that relaxes and widens blood vessels — an extra mechanism that helps lower blood pressure.
Company & origin
Originated / developed by: Janssen Pharmaceutica.
Nebivolol was discovered by chemists at Janssen Pharmaceutica (Belgium) in the 1980s and first approved in Germany in 1997 (marketed in Europe as Nebilet by Menarini); US rights were licensed and it was approved as Bystolic in 2007.
What it treats
Conditions Nebivolol is used for
Practical use
How to take Nebivolol
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take nebivolol regularly at the same time each day, with or without food, as advised by your prescriber.
- Do not stop it suddenly, as stopping a beta-blocker abruptly can cause a rebound rise in blood pressure or worsening heart symptoms; reduce only on medical advice.
- Rise slowly from sitting or lying down when you start treatment, as dizziness is more likely early on.
- Remember that beta-blockers can hide the usual warning signs of low blood sugar, which is important if you have diabetes.
- Report a very slow pulse, marked breathlessness, ankle swelling or unusual fatigue to your prescriber.
Weighing it up
Advantages & disadvantages of Nebivolol
Advantages
- Heart-selective, so it tends to have fewer airway effects than older, non-selective beta-blockers.
- Usually taken once daily, which is convenient.
- Effective for lowering blood pressure and has a role in stable heart failure in older people.
- Generally well tolerated by many patients.
Disadvantages
- Must not be stopped suddenly because of the risk of rebound symptoms.
- Can still cause tiredness, dizziness, headache and cold extremities.
- May mask the early warning signs of low blood sugar.
- Caution is needed in asthma and certain heart-rhythm or circulation problems.
Practical use
Good to know
Nebivolol is taken once a day and is often chosen in older adults, in whom it is well studied for both blood pressure and heart failure. As with all beta-blockers, it must never be stopped abruptly — stopping suddenly can cause a rebound with a racing heart or rising blood pressure, so it is tapered if it needs to come off. Being heart-selective makes it somewhat better tolerated in people with mild airway concerns, but caution still applies in asthma. Some people feel tired or dizzy at first; this often settles, and it can mask the warning signs of a hypo in people with diabetes.
Who should not take it / use with caution
- People with asthma or certain other reactive airway conditions — caution applies even though it is heart-selective.
- People with certain slow or abnormal heart rhythms (such as some heart blocks), very low blood pressure, or unstable/decompensated heart failure.
- Used with caution in significant liver disease, in diabetes (it can mask some hypo warning signs), and in poor circulation.
Monitoring
- Heart rate and blood pressure, especially when starting and after increases
- Symptoms of heart failure where relevant
- Tolerability
Side effects
- Tiredness, headache, dizziness or light-headedness (especially when starting), and cold hands and feet.
- A slow heart rate or low blood pressure in some people.
- Less commonly, sleep disturbance or vivid dreams, low mood, or masking of the warning signs of low blood sugar in people with diabetes.
Key interactions
- Other heart-rate-slowing or blood-pressure-lowering medicines (such as some calcium-channel blockers like diltiazem and verapamil, or digoxin) can add to its effects and need care.
- It can mask hypo warning signs alongside diabetes medicines, including insulin.
- Care with medicines for the heart rhythm and with anything that lowers blood pressure further — share your full medicine list.
Available as: Tablets (several strengths).
Answers
Nebivolol: frequently asked questions
What does "cardioselective" mean?
It means nebivolol acts mainly on the heart, with relatively less effect on other parts of the body such as the airways. This can make it somewhat better tolerated than older, non-selective beta-blockers, though caution in asthma still applies.
Can I stop nebivolol suddenly?
No — like all beta-blockers, it should never be stopped abruptly. Doing so can cause a rebound with a fast heart rate or rising blood pressure. If it needs stopping, it is reduced gradually under medical guidance.
Why is it often used in older adults?
Nebivolol is well studied in older adults for both high blood pressure and heart failure, and its heart-selective action with some blood-vessel relaxation makes it a practical, generally well-tolerated choice in this group.
I have asthma — is nebivolol safe for me?
Because it is heart-selective it affects the airways less than older beta-blockers, but caution still applies and it may be avoided in asthma. Always tell your prescriber about any asthma or breathing condition so the right decision is made.
What is the difference between nebivolol and Nebilet or Bystolic?
They are the same medicine — nebivolol is the generic (active-ingredient) name, Nebilet is a UK brand and Bystolic is the US brand. The active ingredient is identical.
The wider class
About Beta-blockers
Nebivolol belongs to the beta-blockers class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
Browse by body system
Authoritative sources
- BNF: Nebivolol.
- electronic Medicines Compendium (SmPC): Nebivolol (Nebilet).
- NICE NG136: Hypertension in adults.
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