📋 Indications & Clinical Dosage
*Essential hypertension not adequately controlled by Nebivolol alone:*
Adult: 1 Tab once daily (consult product literature).
Children: Not recommended.
⛔ Contraindications
Acute heart failure, cardiogenic shock or episodes of heart failure decompensation requiring IV inotropic therapy, severe renal impairment, hepatic impairment, sick sinus syndrome, 2nd and 3rd degree AV block (without a pacemaker). Bradycardia, hypotension, (systolic blood pressure < 90 mmHg), severe peripheral circulatory disturbances, history of bronchospasm and bronchial asthma, untreated phaeochromocytoma, metabolic acidosis, refractory hypokalaemia, hypercalcaemia, hyponatraemia and symptomatic hyperuricaemia.
⚠️ Precautions & Warnings
Heart failure (avoid if un-controlled), COPD, hyperthyroidism, renal or hepatic impairment, psoriasis, elderly. Initiaite alpha blocker prior to the use of beta blocker. Check serum electrolytes levels before starting treatment.
🔄 Drug Interactions
Class-1 antiarrhythmics, calcium channel blockers, centrally-acting antihypertensives, lithium (avoid), Class-3 antiarrhythmics, anaesthetics, insulin, antidiabetics, calcium antagonists of the dihydropyridine type, antipsychotics, antidepressants, NSAIDs, sympathomimetics, calcium salts, digitalis glycosides, non-depolarizing skeletal muscle relaxants, pressor amines, anti-gout drugs, amantadine, salicylates, antipsychotics, barbiturates, narcotics.
⚠️ Adverse Reactions / Side Effects
Headache, dizziness, paraesthesia, dyspnoea, nausea, constipation, diarrhoea, oedema, fatigue, cardiovascular effects including bradycardia, postural hypotension, depression, increased AV block, cardiac arrhythmias, Raynaud's phenomenon, cold extremities, sexual dysfunction, GI upset, sleep and CNS disturbances, peripheral neuropathy, arthralgia, myopathy, altered blood sugar haematology and lipid levels, increased serum potassium. Rarely, heart failure, bronchospasm, vertigo.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated
Lactation / Breastfeeding:
Contraindicated
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.