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Specific Safety Concerns With Nebivolol

Specific Warnings and Precautions With Nebivolol

Some warnings and precautions to be aware of prior to taking nebivolol include the following:
  • As with all beta blockers, you should not abruptly stop taking nebivolol, as serious problems (including heart attacks) may result. Your healthcare provider will advise you on how to safely stop taking this medication. People are usually recommended to slowly reduce the dose over a period of one to two weeks, with careful monitoring. It is best to minimize physical activity during this time. Let your healthcare provider know if you develop chest pain or any other problems while stopping nebivolol.
  • Like all beta blockers, nebivolol can worsen heart failure in some situations. However, beta blockers are also useful for the treatment of heart failure. If you have heart failure, your healthcare provider may need to monitor you more closely while you take nebivolol. Let your healthcare provider know immediately if your heart failure symptoms seem to worsen.
  • Other beta blockers have been shown to be beneficial for treating angina (chest pain) or for preventing problems after a heart attack. However, nebivolol has not been studied in people with chest pain or who have had a recent heart attack. Nebivolol may also provide such benefits, but this should not be assumed to be the case.
  • Beta blockers can worsen breathing problems like asthma or COPD. While "cardioselective" beta blockers (whose actions are mostly limited to the heart and blood vessels) are less likely to cause this problem, it may still occur. It should be noted that nebivolol is cardioselective only in doses less than 10 mg per day for most people. At higher doses (or in some people who metabolize the medication differently than normal), nebivolol is not cardioselective, meaning that it may have a significant effect on the lungs.
  • If you will be having surgery, make sure your surgeon and anesthesiologist know you take nebivolol, as it may affect the choice of medications used during the surgery.
  • Beta blockers can mask some of the symptoms of low blood sugar (hypoglycemia), particularly the "racing heart" feeling. This can cause serious problems for people with diabetes, who need to be able to sense that they have low blood sugar in order to correct it before it becomes life-threatening. Some beta blockers may also worsen low blood sugar, although it is not known if this is a problem for nebivolol.
  • Beta blockers can mask some of the symptoms of an overactive thyroid (hyperthyroidism). Stopping nebivolol suddenly could cause a "thyroid storm" (a sudden and severe worsening of hyperthyroidism symptoms).
  • Nebivolol may worsen peripheral artery disease (PAD). If you have peripheral artery disease, you may need extra monitoring, and you may have to stop taking nebivolol if your PAD symptoms worsen.
  • Nebivolol can potentially interact with many other medications (see Drug Interactions With Nebivolol).
  • The kidneys and liver help remove nebivolol from the body. Therefore, if you have kidney or liver disease, your healthcare provider may need to monitor your response to this medication more closely, and a lower nebivolol dosage may be recommended. Nebivolol is not recommended for use in people with severe liver disease.
  • If you have an anaphylactic allergy (the type that affects the entire body and often interferes with breathing), nebivolol may make you more sensitive to the allergen and may make the usual treatments (such as epinephrine or an EpiPen®) less effective.
  • If you have a pheochromocytoma, you should not take nebivolol unless you are already taking an alpha blocker medication, as serious problems could occur.
  • Nebivolol is considered a pregnancy Category C medication. This means that it may not be safe for use during pregnancy, although the full risks are not currently known (see Bystolic and Pregnancy).
  • It is not known if nebivolol passes through breast milk in humans. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Bystolic and Breastfeeding).
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