Cardioselective β1-blocker (with NO release)

Nebivolol

Brand names: Nebilet

Nebivolol is a highly beta-1-selective beta-blocker with additional nitric-oxide-mediated vasodilation, used for hypertension and as an adjunct for stable mild-to-moderate heart failure in older patients.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Can be taken with and without food. Individualize to the needs of the patient and monitor during up-titration. ( 2 ) Hypertension: Most patients start at 5 mg once daily. Dose can be increased at 2-week intervals up to 40 mg. ( 2.1 ) 2.1 Hypertension The dose of nebivolol tablets must be individualized to the needs of the patient. For most patients, the recommended starting dose is 5 mg once daily, with or without food, as monotherapy or in combination with other agents. For patients requiring further reduction in blood pressure, the dose can be increased at 2-week intervals up to 40 mg. A more frequent dosing regimen is unlikely to be beneficial. Renal Impairment In patients with severe …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-10-31. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It selectively blocks beta-1 adrenoceptors, reducing heart rate, myocardial contractility and renin release; it also promotes endothelial nitric oxide release, producing peripheral vasodilation.

Prescribing in practice

Avoid in asthma and other reversible obstructive airways disease, and in marked bradycardia, second- or third-degree heart block, sick sinus syndrome and decompensated heart failure.
Do not stop abruptly, particularly in ischaemic heart disease, as this risks rebound angina or arrhythmia; withdraw gradually.
May mask the warning signs of hypoglycaemia, such as tachycardia, in patients with diabetes.

Monitoring

Monitor heart rate and blood pressure; in heart failure assess clinical status closely after initiation and dose changes, watching for fluid retention or worsening symptoms.

Counselling the patient

Do not stop the tablets suddenly without medical advice.
It may cause tiredness, headache or dizziness, especially when starting.
If you have diabetes, be aware it can hide the usual warning signs of a low blood sugar.

Evidence & guidelines

Guideline-recommended option for hypertension and for heart failure in older people (NICE NG136; NICE NG106).

Reference: NICE NG136/NG106; ESC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways