Nebivolol Disease Interactions
There are 18 disease interactions with nebivolol.
- Bradyarrhythmia/AV block
- Cardiogenic shock/hypotension
- CHF
- Diabetes
- Hypersensitivity
- Ischemic heart disease
- PVD
- Hepatic impairment
- Cerebrovascular insufficiency
- Glaucoma
- Hyperlipidemia
- Hyperthyroidism
- Myasthenia gravis
- Pheochromocytoma
- Psoriasis
- Tachycardia
- Asthma/COPD
- Renal impairment
Beta-blockers (applies to nebivolol) bradyarrhythmia/AV block
Major Potential Hazard, High plausibility. Applicable conditions: Heart Block, Sinus Node Dysfunction
The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.
Beta-blockers (applies to nebivolol) cardiogenic shock/hypotension
Major Potential Hazard, High plausibility.
The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.
Beta-blockers (applies to nebivolol) CHF
Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure
Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Sympathetic stimulation may be important in maintaining the hemodynamic function in these patients, thus beta-blockade can worsen the heart failure. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Carvedilol, specifically, is indicated for use with these agents in the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.
Beta-blockers (applies to nebivolol) diabetes
Major Potential Hazard, High plausibility. Applicable conditions: Diabetes Mellitus
Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.
Beta-blockers (applies to nebivolol) hypersensitivity
Major Potential Hazard, High plausibility. Applicable conditions: Allergies
The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.
Beta-blockers (applies to nebivolol) ischemic heart disease
Major Potential Hazard, High plausibility.
Heightened sensitivity to catecholamines may occur after prolonged use of beta-adrenergic receptor blocking agents (aka beta-blockers). Exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt withdrawal of therapy. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Patients should be advised not to discontinue treatment without first consulting with the physician. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures.
Beta-blockers (applies to nebivolol) PVD
Major Potential Hazard, High plausibility. Applicable conditions: Peripheral Arterial Disease
Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Therapy with beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.
Nebivolol (applies to nebivolol) hepatic impairment
Major Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease
Metabolism of nebivolol is decreased in patients with moderate hepatic impairment. d-Nebivolol peak plasma concentration increased 3-fold, exposure (AUC) increased 10-fold, and the apparent clearance decreased by 86% in patients with moderate hepatic impairment (Child-Pugh Class B). Patients with liver disease may be at greater risk for adverse effects from nebivolol due to decreased drug clearance. Therapy with nebivolol should be administered cautiously in patients with liver disease. Dosage adjustments may be necessary. No formal studies have been performed in patients with severe hepatic impairment and nebivolol should be contraindicated for these patients.
Beta-blockers (applies to nebivolol) cerebrovascular insufficiency
Moderate Potential Hazard, Moderate plausibility.
Beta-adrenergic blocking agents (beta-blockers), should be used with caution in patients with cerebrovascular insufficiency because of their potential effects relative to blood pressure and pulse. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.
Beta-blockers (applies to nebivolol) glaucoma
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension
Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.
Beta-blockers (applies to nebivolol) hyperlipidemia
Moderate Potential Hazard, Moderate plausibility.
Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles. Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Patients with preexisting hyperlipidemia may require closer monitoring during beta-blocker therapy, and adjustments made accordingly in their lipid-lowering regimen.
Beta-blockers (applies to nebivolol) hyperthyroidism
Moderate Potential Hazard, High plausibility.
When beta-adrenergic receptor blocking agents (aka beta-blockers) are used to alleviate symptoms of hyperthyroidism such as tachycardia, anxiety, tremor and heat intolerance, abrupt withdrawal can exacerbate thyrotoxicosis or precipitate a thyroid storm. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.
Beta-blockers (applies to nebivolol) myasthenia gravis
Moderate Potential Hazard, Low plausibility. Applicable conditions: Myoneural Disorder
Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.
Beta-blockers (applies to nebivolol) pheochromocytoma
Moderate Potential Hazard, Moderate plausibility.
Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.
Beta-blockers (applies to nebivolol) psoriasis
Moderate Potential Hazard, Moderate plausibility.
The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.
Beta-blockers (applies to nebivolol) tachycardia
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Tachyarrhythmia
Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol. The use of beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in these patients.
Cardioselective beta-blockers (applies to nebivolol) asthma/COPD
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease
Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.
Nebivolol (applies to nebivolol) renal impairment
Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction
Renal clearance of nebivolol is decreased in patients with severe renal impairment. The apparent clearance of nebivolol was unchanged following a single 5 mg dose of nebivolol in patients with mild renal impairment (CrCl 50 to 80 mL/min, n =7), and it was reduced negligibly in patients with moderate (CrCl 30 to 50 mL/min, n =9), but clearance was reduced by 53% in patients with severe renal impairment (CrCl<30 mL/min, n =5). Patients with severe renal impairment may be at greater risk for adverse effects from nebivolol due to decreased drug clearance. Therapy with nebivolol should be administered cautiously in patients with severe renal impairment. Dosage adjustments may be necessary. No studies have been conducted in patients on dialysis
Nebivolol drug interactions
There are 510 drug interactions with nebivolol.
Nebivolol alcohol/food interactions
There are 3 alcohol/food interactions with nebivolol.
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Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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