Nebil Dosage/Direction for Use

Hypertension: Adult: 1 tablet (5 mg) daily, preferably at the same time of the day. Tablets may be taken with or without meals. The initial up titration should be done at 1-2 weekly intervals based on patient tolerability. The maximum recommended dose is 10 mg once daily. The blood pressure-lowering effect becomes evident after 1-2 weeks of treatment. Occasionally, the optimal effect is reached only after 4 weeks.
During the titration phase, in case of worsening of the heart failure or intolerance, it is recommended first to reduce the dose of nebivolol, or to stop it immediately if necessary (in case of severe hypotension, worsening of heart failure with acute pulmonary edema, cardiogenic shock, symptomatic bradycardia or AV block).
Patients with Renal Insufficiency: The recommended starting dose is 2.5 mg daily, if needed, the daily dose may be increased to 5 mg. The upward titration should be performed cautiously.
Patients with Hepatic Insufficiency: In patients with moderate hepatic insufficiency, the recommended initial dose is 2.5 mg once daily. Upward titration should be performed cautiously if needed.
Elderly >65 years: The recommended starting dose is 2.5 mg daily. If needed, the daily dose may be increased to 5 mg.
Chronic Heart Failure: The treatment of stable chronic heart failure has to be initiated with a gradual up titration of dosage until the optimal individual maintenance dose is reached.
Patients should have stable chronic heart failure without acute failure during the past 6 weeks. It is recommended that the treating physician should be experienced in the management of chronic heart failure.
For those patients receiving cardiovascular drug therapy including diuretics and/or digoxin and/or ACE inhibitors and/or angiotensin II antagonists, dosing of these drugs should be stabilized during the past 2 weeks prior to initiation of nebivolol treatment.