Nebicard 2.5mg Tablet 1 Strip

✔️ Nebivolol lowers blood pressure and cardiac workload through multiple mechanisms

• Reduction in heart rate
• Decrease in myocardial contractility
• Suppression of sympathetic nerve activity
• Inhibition of renin release
• Vasodilation leading to reduced peripheral vascular resistance

✔️ Nebicard should not be used in patients with:

• Severe bradycardia
• Heart block (greater than first degree)
• Cardiogenic shock
• Decompensated heart failure
• Sick sinus syndrome (unless pacemaker present)
• Severe hepatic impairment (Child-Pugh C)
• Known hypersensitivity to nebivolol

✔️ Drug Interaction Studies

Digoxin: No clinically significant pharmacokinetic interaction

Warfarin: No effect on anticoagulant activity, INR, or drug levels

CYP2D6 inhibitors (e.g., quinidine, fluoxetine, paroxetine): May increase nebivolol exposure—use caution

✔️ Use caution when Nebicard is combined with:

• Calcium channel blockers (verapamil, diltiazem)
• Antiarrhythmics (e.g., disopyramide)
• Digitalis glycosides
• Catecholamine-depleting agents (reserpine, guanethidine)
• Clonidine (Nebicard should be withdrawn before clonidine tapering)
• Concurrent use with other beta-blockers is not recommended.

✔️ Dosage & Administration

Initial dose: 5 mg once daily, with or without food

Dose titration: May be increased at 2-week intervals based on response

Maximum dose: Up to 40 mg daily

More frequent dosing does not enhance therapeutic benefit

⚠️ Dose adjustment is required in moderate hepatic impairment. Severe hepatic impairment is a contraindication.

Renal impairment: Use cautiously in severe cases; not studied in dialysis patients

Hepatic impairment: Use cautiously in moderate impairment; contraindicated in severe cases

Anaphylaxis risk: Reduced response to epinephrine may occur in allergic individuals

✔️ Precautions & Warnings

Abrupt Discontinuation

Sudden withdrawal may worsen angina, cause myocardial infarction, or trigger arrhythmias

Gradual dose tapering over 1–2 weeks is recommended

Heart Failure

Use cautiously in compensated CHF

Discontinue if cardiac function deteriorates

Respiratory Disease

Generally avoided in patients with bronchospastic disorders

Diabetes

May mask symptoms of hypoglycemia such as tachycardia

Thyroid Disorders

May conceal signs of hyperthyroidism; abrupt withdrawal can precipitate thyroid storm

Peripheral Vascular Disease

Symptoms may worsen; use with caution

Anesthesia

Monitor closely during surgery; beta-blockade may impair cardiovascular reflexes

✔️ Storage:

Store below 30°C

Protect from light and moisture

Keep out of reach of children