Bivolol

Essential HTN. Stable mild & moderate chronic heart failure in addition to standard therapies in elderly ≥70 yr.

HTN Adult 5 mg daily, preferably at the same time of the day. An additional antihypertensive effect has been observed when combined w/ hydrochlorothiazide 12.5-25 mg. Patient w/ renal insufficiency & elderly >65 yr Initially 2.5 mg daily, may be increased to 5 mg if needed. Chronic heart failure Initially 1.25 mg, increased at 1-2 wkly intervals to 2.5 mg once daily, then to 5 mg once daily & then to 10 mg once daily. Max: 10 mg once daily.

Should be taken with food: May be taken w/ meals.

Hypersensitivity. Acute heart failure, cardiogenic shock or episodes of heart failure decompensation requiring IV inotropic therapy. Sick sinus syndrome including SA block. 2nd- & 3rd-degree heart block (w/o a pacemaker). History of bronchospasm & bronchial asthma. Untreated phaeochromocytoma. Metabolic acidosis. Bradycardia (heart rate <60 bpm prior to therapy). Hypotension (systolic BP <90 mmHg). Severe peripheral circulatory disturbances. Liver insufficiency or liver function impairment.

May increase sensitivity to allergens & severity of anaphylactic reactions. Not to be used in patients w/ untreated CHF unless condition has been stabilized. May induce bradycardia. Patients w/ peripheral circulatory disorders (Raynaud's disease or syndrome, intermittent claudication); 1st degree heart block; Prinzmetal's angina; diabetic patients; those w/ hyperthyroidism; COPD; history of psoriasis. Not to be abruptly discontinued unless clearly indicated. Treatment should be gradually discontinued in patients w/ ischemic heart disease ie, over 1-2 wk. Not recommended in combination w/ Ca channel antagonists of the verapamil & diltiazem type, class I antiarrhythmic drugs, & centrally acting antihypertensive drugs. Concomitant use w/ certain anesth that cause myocardial depression. Not to be used during pregnancy unless clearly necessary. Not recommended during lactation. Not recommended in childn & adolescents. Exercise caution in elderly >75 yr. Chronic heart failure: Initiation of treatment necessitates regular monitoring. Not recommended in patients w/ renal insufficiency.

Headache, dizziness, paraesthesia, dyspnoea, constipation, nausea, diarrhoea, tiredness, oedema.

Effect on AV conduction time may be potentiated & -ve inotropic effect be increased w/ class I antiarrhythmics (quinidine, hydroquinidine, cibenzoline, flecainide, disopyramide, lidocaine, mexiletine, propafenone). -ve influence on contractility & AV conduction w/ Ca channel antagonists of verapamil/diltiazem type. May worsen heart failure by a decrease in central sympathetic tonus w/ centrally-acting antihypertensives (clonidine, guanfacine, moxonidine, methyldopa, rilmenidine). Effect on AV conduction time may be potentiated w/ amiodarone. May attenuate reflex tachycardia & increase risk of hypotension w/ volatile halogenated anaesth. May mask certain symptoms of hypoglycemia (palpitations, tachycardia) w/ insulin & oral antidiabetic drugs. Increased fall in BP w/ baclofen & amifostine. Concomitant use w/ digitalis glycosides, Ca antagonists of the dihydropyridine type (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nitrendipine), antipsychotics, antidepressants (tricyclics, barbiturates & phenothiazines), NSAIDs, sympathomimetic agents. May lead to increased plasma levels w/ bupropion, paroxetine, fluoxetine, thioridazine, quinidine, chloroquine, levomepromazin, terbinafine & cimetidine. Slightly increased plasma levels of both nebivolol & nicardipine when co-administered.

Beta-Blockers

C07AB12 - nebivolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

Rx