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Anaesthesia: Caution should be observed with certain anaesthetics that cause myocardial depression. The patient can be protected against vagal reactions by intravenous administration of atropine.
Cardiovascular: In general, beta-blockers should not be used in patients with untreated congestive heart failure (CHF), unless their condition has been stabilized.
In patients with ischemic heart disease, treatment with beta-blockers should be discontinued gradually, i.e. over 1-2 weeks. If necessary, replacement therapy should be initiated at the same time to prevent exacerbation of angina pectoris.
Beta-blockers may induce bradycardia: if the pulse rate drops below 50-55 bpm at rest and/or the patient experiences symptoms that are suggestive of bradycardia, the dosage should be reduced.
Beta-blockers should be used with caution: in patients with peripheral circulatory disorders (Raynaud's disease or syndrome, intermittent claudication), as aggravation of these disorders may occur; in patients with first degree heart block, because of the negative effect of beta-blockers on conduction time; in patients with Prinzmetal's angina due to unopposed alpha-receptor mediated coronary artery vasoconstriction: beta-blockers may increase the number and duration of anginal attacks.
Combination of nebivolol with calcium channel antagonists of the verapamil and diltiazem type, with Class I antiarrhythmic drugs, and with centrally acting antihypertensive drugs is generally not recommended.
Metabolic/Endocrinological: Nebivolol does not affect glucose levels in diabetic patients. Care should be taken in diabetic patients, however, as nebivolol may mask certain symptoms of hypoglycemia (tachycardia, palpitations).
Beta-blockers may mask tachycardic symptoms in hyperthyroidism. Abrupt withdrawal may intensify symptoms.
Respiratory: In patients with chronic obstructive pulmonary disorders, beta-blockers should be used with caution as airway constriction may be aggravated.
Other: Patients with a history of psoriasis should take beta-blockers only after careful consideration.
Beta-blockers may increase the sensitivity to allergens and the severity of anaphylactic reactions.
The initiation of Chronic Heart Failure treatment with nebivolol necessitates regular monitoring. Treatment discontinuation should not be done abruptly unless clearly indicated.
