Nebivolol

Orally, preferably at the same time of the day, regardless of the meal time, without chewing and drinking plenty of liquid.

Hypertension and Coronary Heart Disease

The average daily dose of nebivolol is 2.5–5 mg 1 time per day. For patients with renal insufficiency and patients older than 65 years, an initial dose of nebivolol 2.5 mg / day is recommended.

If necessary, the daily dose of nebivolol can be increased to 10 mg (in one step). The optimal therapeutic effect becomes pronounced after 1-2 weeks of taking the drug, and in some cases - after 4 weeks. Nebivolol can be used in combination therapy with other drugs that reduce blood pressure.

Chronic heart failure

The dose of nebivolol is selected gradually until an individual optimal maintenance dose is reached. It is necessary to begin treatment of chronic heart failure with β-adrenoreceptor blockers in a clinically stable state over the past two weeks.

Treatment begins with a dose of 1.25 mg 1 time per day with a gradual increase (at intervals of at least 2 weeks) to 2.5–5 mg 1 time per day, if necessary up to a maximum dose of 10 mg 1 time per day. The patient must be under the supervision of a physician for 2 hours after taking the first dose of the drug, as well as after each subsequent dose increase. During the selection of the dosing regimen in case of worsening of the course of chronic heart failure or intolerance of the drug, it is recommended to reduce the dose of nebivolol or stop taking it. Reception of nebivolol is not recommended to stop abruptly (if it is not necessary), since this may lead to a temporary exacerbation of the symptoms of heart failure. If it is necessary to stop taking the drug, the cancellation is carried out gradually, halving the dose twice a week.

Patients with a renal failure (KK less than 20 ml / min.)

The initial dose is 2.5 mg / day. If necessary, the daily dose can be increased to 5 mg. In patients with impaired renal function (QC less than 20 ml / min), the dose should be increased with extreme caution.

Elderly patients

For patients older than 65 years, the initial dose is 2.5 mg / day. If necessary, the daily dose can be increased to 5 mg. However, taking into account the limited experience of using the drug in elderly patients, it is necessary to be careful and conduct a thorough examination of patients over the age of 65 years. Elderly patients do not need to adjust the dose, so it is necessary to individually select the dose, gradually increasing it to the maximum tolerated dose.

Nebivolol can have a harmful effect on the course of pregnancy, on the fetus and the newborn. Reduction of placental perfusion under the action of
β-blockers can cause fetal developmental delay, fetal death, miscarriage, and premature birth. Newborns may experience bradycardia, lower blood pressure, hypoglycemia, and respiratory paralysis. Use during pregnancy is possible only if the expected benefit to the mother outweighs the potential risk to the fetus. Nebivolol should be discontinued 48-72 hours before delivery. In cases where this is not possible, it is necessary to ensure strict monitoring of newborns within 48-72 hours after delivery.

Animal studies have shown that nebivolol is excreted in milk from lactating animals. If necessary, the use of the drug during lactation breastfeeding should be stopped.

Cancellation of β-blockers should be carried out gradually over 10 days (up to 2 weeks in patients with ischemic heart disease).

Control of blood pressure and heart rate at the beginning of the drug should be daily.

In elderly patients, monitoring of renal function is necessary (1 time in 4-5 months). In case of angina, the dose of the drug should provide a heart rate at rest within
55-60 beats / min, with a load - no more than 110 beats / min.

β-blockers can cause bradycardia: the dose should be reduced if the heart rate is less than 50-55 beats / min (see section "Contraindications").

When deciding on the use of the drug Nebivolol in patients with psoriasis, one should carefully relate the perceived benefits of using the drug and the possible risk of exacerbation of the course of psoriasis.

Patients using contact lenses should take into account that, with the use of β-blockers, there may be a decrease in the production of tear fluid.

When performing surgical interventions, the anesthesiologist should be warned that the patient is taking β-blockers.

Nebivolol does not affect plasma glucose concentration in patients with diabetes mellitus. However, caution should be exercised in treating these patients, since Nebivolol may mask certain symptoms of hypoglycemia (for example, tachycardia) caused by the use of hypoglycemic oral and insulin drugs. Control of plasma glucose concentration should be carried out 1 time in 4-5 months. (in diabetic patients).

With hyperfunction of the thyroid gland, β-blockers may mask tachycardia.

β-blockers should be used with caution in patients with chronic obstructive pulmonary disease, as bronchospasm may increase.

β-blockers can increase the sensitivity to allergens and the severity of anaphylactic reactions.

In smokers, the effectiveness of β-adrenergic blockers is lower compared with non-smoking patients.

Impact on ability to drive vehicles and other mechanisms

During the period of treatment, care must be taken when driving and occupying other potentially dangerous activities that require high concentration of attention and speed of psychomotor reactions.

Symptoms: marked reduction in blood pressure, nausea, vomiting, cyanosis, bradycardia, atrioventricular block, acute heart failure, bronchospasm, loss of consciousness, cardiogenic shock, coma, cardiac arrest, hypoglycemia, convulsions.

Treatment: gastric lavage, taking activated carbon. In the case of a pronounced decrease in blood pressure, it is necessary to give the patient a horizontal position with raised legs, if necessary, in / in the introduction of fluid and vazopressorov. For bradycardia, 0.5-2 mg of atropine should be administered intravenously. In the absence of a positive effect, a transvenous or intracardiac pacemaker can be delivered. In case of atrioventricular blockade (II-III stages), it is recommended intravenous injection of β-adrenomimetics, if they are ineffective, consideration should be given to setting up an artificial pacemaker. In heart failure, treatment begins with the introduction of cardiac glycosides and diuretics, in the absence of an effect, the administration of dopamine, dobutamine or vasodilators is advisable. When bronchospasm is used in / in β2-adrenomimetics. In ventricular premature beats, lidocaine may be prescribed (class IA antiarrhythmic drugs are not used). When convulsions is recommended in / in the introduction of diazepam. When hypoglycemia is shown in / in the introduction of dextrose (glucose).