Meta Information
ID:nebivolol
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/beta-blockers
Target name:
Other Beta-Blockers
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Co-administration is redundant and leads to an excessive beta-blocking effect, risking severe bradycardia (slow heart rate), heart block, and hypotension.
Actionable advice:
Avoid using more than one beta-blocker at the same time.
Target id:
/class/cyp2d6-inhibitors
Target name:
CYP2D6 Inhibitors (e.g., Bupropion, Fluoxetine, Paroxetine)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
These drugs block the primary enzyme (CYP2D6) that metabolizes nebivolol, leading to significantly increased nebivolol levels and a higher risk of side effects like bradycardia and hypotension.
Actionable advice:
Avoid this combination or use a much lower dose of nebivolol with careful monitoring.
Target id:
/class/calcium-channel-blockers
Target name:
Non-Dihydropyridine Calcium Channel Blockers (Verapamil, Diltiazem)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Both drug classes slow heart rate and reduce heart muscle contractility, leading to a high risk of severe bradycardia, heart block, and worsening heart failure.
Actionable advice:
This combination is generally avoided unless under close specialist supervision.
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Both drugs slow electrical conduction through the heart's AV node, which additively increases the risk of advanced or complete heart block and severe bradycardia.
Actionable advice:
Use this combination with extreme caution and regular ECG monitoring.
Target id:
/condition/heart-failure
Target name:
Acute Decompensated Heart Failure
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
While used for stable chronic heart failure, initiating nebivolol during an acute decompensation can worsen cardiac function and is contraindicated.
Actionable advice:
Only use for stable heart failure under a doctor's supervision, starting with a very low dose and titrating slowly.
Target id:
/condition/hepatic-impairment
Target name:
Severe Hepatic Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Severe liver impairment significantly reduces the clearance of nebivolol, leading to much higher drug levels and an increased risk of side effects.
Actionable advice:
Use is contraindicated in severe liver impairment and requires dose reduction in moderate impairment.
Target id:
/procedure/general-anesthesia
Target name:
General Anesthesia
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
The combination of nebivolol and general anesthetics can lead to excessive depression of heart function and severe hypotension during surgery.
Actionable advice:
Always inform your anesthesiologist that you are taking nebivolol before any surgery.
Target id:
/intervention/clonidine
Target name:
Clonidine
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Abruptly stopping clonidine while taking a beta-blocker can cause a dangerous rebound hypertensive crisis due to unopposed alpha-adrenergic activity.
Actionable advice:
If discontinuing this combination, the beta-blocker should be stopped several days before gradually tapering clonidine.
Target id:
/class/antihypertensives
Target name:
Other Antihypertensive Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Additive effects can lead to excessive blood pressure lowering (hypotension), causing dizziness, lightheadedness, or fainting.
Actionable advice:
Monitor blood pressure closely when combining with other blood pressure medications.
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Nebivolol can mask the warning signs of low blood sugar (hypoglycemia), such as a rapid heartbeat and tremors, making it difficult to recognize an episode.
Actionable advice:
Monitor blood glucose levels closely and be aware that typical hypoglycemia symptoms may be absent.
Target id:
/class/nsaids
Target name:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Description:
NSAIDs can reduce the blood pressure-lowering effect of nebivolol by inhibiting prostaglandins and causing the body to retain salt and water.
Actionable advice:
Limit the use of NSAIDs and monitor blood pressure if they are used concurrently.
Target id:
/condition/asthma-copd
Target name:
Asthma and COPD
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Although nebivolol is beta-1 selective, this selectivity can be lost at higher doses, potentially causing bronchospasm in susceptible individuals.
Actionable advice:
Use with caution in patients with bronchospastic diseases; start with the lowest possible dose.
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Kidney impairment can reduce the clearance of nebivolol's active metabolites, potentially increasing its effects and the risk of side effects.
Actionable advice:
A lower starting dose is recommended for individuals with severe renal impairment.
Target id:
/class/pde5-inhibitors
Target name:
PDE5 Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Both nebivolol and PDE5 inhibitors (like sildenafil) lower blood pressure, and their combined use can lead to an additive drop, causing dizziness or fainting.
Actionable advice:
Use with caution and consider separating doses; start with the lowest dose of the PDE5 inhibitor.
Target id:
/dietary/alcohol-acute
Target name:
Alcohol
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Alcohol can enhance the blood pressure-lowering effect of nebivolol, increasing the risk of dizziness, lightheadedness, and fainting.
Actionable advice:
Limit or avoid alcohol consumption while taking this medication.
Target id:
/class/cyp2d6-inducers
Target name:
CYP2D6 Inducers (e.g., Rifampin)
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Description:
These drugs speed up the metabolism of nebivolol via the CYP2D6 enzyme, which can lower its concentration in the blood and reduce its effectiveness.
Actionable advice:
Monitor blood pressure and heart rate for lack of efficacy; a dose increase of nebivolol may be needed.
Target id:
/class/antipsychotics
Target name:
Antipsychotic Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Both classes of drugs can cause hypotension, and the risk is increased when they are used together. Some antipsychotics are also CYP2D6 inhibitors, further increasing nebivolol levels.
Actionable advice:
Monitor blood pressure closely when using this combination.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Beta-blockers can reduce placental perfusion and may cause adverse effects in the fetus and newborn, such as bradycardia and hypoglycemia.
Actionable advice:
Avoid use during pregnancy unless the potential benefit justifies the potential risk to the fetus.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
It is not known if nebivolol is excreted in human milk, but due to the potential for serious adverse reactions in nursing infants, its use is generally not recommended.
Actionable advice:
A decision should be made whether to discontinue nursing or to discontinue the drug.
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
requirement
Nature:
absolute
Description:
Food can increase the absorption of nebivolol. To maintain stable drug levels and consistent effects, it should be taken in the same manner each day.
Actionable advice:
Take nebivolol at the same time each day, consistently either with or without food.
Target id:
/intervention/exercise
Target name:
Exercise
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Description:
Nebivolol blunts the normal increase in heart rate during exercise, which is an expected therapeutic effect but can affect training metrics based on heart rate zones.
Actionable advice:
Do not use target heart rate zones for training; use Rate of Perceived Exertion (RPE) instead.
Target id:
/condition/peripheral-vascular-disease
Target name:
Peripheral Vascular Disease / Raynaud's
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Description:
Beta-blockers can potentially worsen symptoms of poor circulation in the extremities, although nebivolol's vasodilating properties may mitigate this compared to other beta-blockers.
Actionable advice:
Monitor for worsening symptoms like cold or painful fingers and toes.