Nebivolol Tablets

Nebivolol is a beta blocker with a pharmacological profile that distinguishes it from older medicines in the same class. Nebivolol tablets are prescribed in adults for the treatment of hypertension (high blood pressure) and, in patients aged 70 and over, as an adjunctive treatment for stable mild to moderate chronic heart failure. Nebivolol combines cardioselective beta-1 blockade with a vasodilatory effect mediated through nitric oxide, making it a useful option in cardiovascular therapy. A prescription can only be issued following a clinical consultation.

Nebivolol tablets are an oral prescription medicine containing nebivolol hydrochloride as the active ingredient. Nebivolol is a highly cardioselective beta-1 adrenoceptor blocker. It is distinguished from many other beta blockers by a secondary mechanism that stimulates the release of nitric oxide from blood vessel endothelial cells. Nitric oxide causes vascular smooth muscle to relax and blood vessels to widen, producing a vasodilatory effect that contributes to blood pressure lowering alongside the cardiac effect of beta blockade.

Nebivolol is licensed in the UK for two indications. First, it is used for the treatment of hypertension in adults. Second, it is used as an adjunctive treatment in the stabilisation of chronic stable mild to moderate heart failure in patients aged 70 and over. This second indication is restricted to older patients and requires careful dose titration under medical supervision. Not all patients aged 70 and over with heart failure will be appropriate for nebivolol, your prescriber will determine suitability.

Three strengths are available through this service: 2.5 mg, 5 mg, and 10 mg. The 2.5 mg tablet is particularly relevant to the heart failure indication, where dose titration begins at 1.25 mg (half a 2.5 mg tablet) and increases slowly over weeks. The 5 mg tablet is the standard starting dose for hypertension.

Nebivolol lowers blood pressure and supports heart function through two complementary mechanisms.

Beta-1 Adrenoceptor Blockade

Nebivolol is a highly selective beta-1 adrenoceptor blocker. Beta-1 receptors are found predominantly in the heart. By blocking these receptors, nebivolol reduces the heart rate and the force of each cardiac contraction. This reduces cardiac output, which lowers blood pressure. Nebivolol also reduces renin release from the kidneys, providing an additional contribution to blood pressure regulation through its effect on the renin angiotensin system.

Nitric Oxide Mediated Vasodilation

Nebivolol also stimulates the release of nitric oxide from the endothelial cells that line blood vessels. Nitric oxide causes vascular smooth muscle to relax, leading to widening of the blood vessels (vasodilation). This peripheral vasodilation reduces the resistance against which the heart pumps, contributing a further blood pressure lowering effect that is additive to the reduction in cardiac output from beta blockade.

The combination of reduced cardiac output and peripheral vasodilation via nitric oxide gives nebivolol a haemodynamic profile that differs from older, less cardioselective beta blockers. This profile may be associated with less of the cold extremities and metabolic side effects seen with some non-selective beta blockers, though side effects as listed in the SmPC remain possible with nebivolol.

Always take nebivolol exactly as your prescriber instructs. The information below summarises key points from the current UK SmPC. Read the Patient Information Leaflet supplied with your medicine before starting treatment.

For Hypertension

• Take one 5 mg tablet once daily, at the same time each day.
• Your prescriber may increase the dose to 10 mg once daily if your blood pressure is not adequately controlled after four weeks on 5 mg.
• Nebivolol can be taken with or without food.

For Heart Failure in Patients Aged 70 and Over

• The starting dose is 1.25 mg once daily (half of a 2.5 mg tablet), with gradual doubling of the dose at intervals of at least two weeks, as tolerated, up to 10 mg once daily.
• Dose increases must be guided by your prescriber. Do not increase the dose yourself.
• If you develop worsening heart failure or low blood pressure during titration, your prescriber may need to reduce the dose or pause the titration schedule.

For both indications:

• Swallow the tablet or half tablet whole with a glass of water.
• If you miss a dose, take it as soon as you remember on the same day. If you only remember the following day, skip the missed dose and continue as normal. Do not take two doses at once.
• Do not stop taking nebivolol suddenly without speaking to your prescriber first. Abrupt withdrawal of a beta blocker can cause a rebound increase in heart rate and blood pressure, and in patients with coronary artery disease may trigger chest pain. Your prescriber will advise on gradual dose reduction if stopping is necessary.

Nebivolol tablets are available in three strengths. The appropriate dose and titration schedule depend on the indication being treated.

Nebivolol 2.5 mg Tablets

The 2.5 mg tablet is primarily used in the heart failure titration protocol. The UK SmPC for nebivolol in heart failure specifies a starting dose of 1.25 mg (half a 2.5 mg tablet) once daily, with gradual doubling every two weeks. The 2.5 mg tablet may also be used in hypertension for patients who require a dose between the 5 mg and 10 mg options, though 5 mg is the standard starting dose for hypertension.

Nebivolol 5 mg Tablets

The 5 mg tablet is the standard starting and maintenance dose for adults with hypertension. Most patients with hypertension will be prescribed 5 mg once daily. If blood pressure remains inadequately controlled after four weeks, the prescriber may consider increasing to 10 mg. The 5 mg dose is also part of the heart failure titration schedule.

Nebivolol 10 mg Tablets

The 10 mg tablet is the maximum recommended daily dose for both hypertension and heart failure in adults. For hypertension, 10 mg once daily is used in patients whose blood pressure is not adequately controlled at 5 mg. In heart failure, 10 mg is the target maintenance dose reached through careful titration. All dose adjustments are made by your prescriber. Do not change your dose without medical advice.

Like all medicines, nebivolol can cause side effects, although not everyone experiences them. The information below is based on the current UK SmPC. Refer to the Patient Information Leaflet for the full list of side effects.

Common Side Effects (may affect up to 1 in 10 people)

• Headache
• Dizziness or lightheadedness
• Fatigue or tiredness
• Slow heart rate (bradycardia). If your resting heart rate becomes very slow or you feel faint, contact your prescriber.
• Oedema (swelling, particularly of the ankles)
• Cold or numb hands and feet. This is a recognised class effect of beta blockers.
• Breathlessness
• Diarrhoea, nausea, or constipation

Uncommon Side Effects (may affect up to 1 in 100 people)

• Low blood pressure (hypotension)
• Sleep disturbances or vivid dreams
• Skin reactions such as rash or itching
• Depression or mood changes

Serious Side Effects: Seek Urgent Medical Attention

Go to your nearest accident and emergency department or call 999 immediately if you experience:

• Worsening breathlessness or wheeze, which may indicate bronchospasm. Although nebivolol is highly cardioselective, it remains contraindicated in reactive airways disease.
• Significantly slow heart rate causing fainting or collapse
• Signs of worsening heart failure such as increasing breathlessness, rapid unexplained weight gain, or worsening ankle swelling
• Signs of a severe allergic reaction such as sudden swelling of the face, lips, tongue, or throat

Report any suspected side effect to your prescriber, pharmacist, or via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Nebivolol Tablets May Be Suitable If You:

• Are an adult with a confirmed diagnosis of hypertension
• Are aged 70 or over with stable mild to moderate chronic heart failure and your prescriber has determined nebivolol is appropriate as an adjunctive treatment
• Are already prescribed nebivolol and require a repeat prescription through an online prescribing service for hypertension

Nebivolol Tablets Are Not Suitable If You:

• Have asthma or significant bronchospasm. Nebivolol is contraindicated in these conditions. Although it is highly cardioselective, it can still cause bronchospasm.
• Have uncontrolled or acutely decompensated heart failure
• Have second or third degree heart block, sick sinus syndrome, or a very slow resting heart rate (below 60 beats per minute before starting treatment)
• Have cardiogenic shock
• Have severe peripheral artery disease
• Have untreated phaeochromocytoma
• Have metabolic acidosis
• Have severe liver disease. Nebivolol is metabolised by the liver and should not be used in patients with significant hepatic impairment.
• Have a known allergy or hypersensitivity to nebivolol or any excipient listed in the SmPC
• Are under 18 years of age

Initiation of nebivolol for heart failure in patients aged 70 and over should be under the supervision of a specialist or a physician experienced in the management of heart failure. The heart failure indication requires a prolonged and carefully monitored dose titration over a period of several months. Online prescribing of nebivolol for heart failure initiation is generally not appropriate through this service. Patients who are already stabilised on nebivolol for heart failure and require a repeat prescription may be able to access this through the online consultation process, subject to the prescriber assessment.

Tell your prescriber about all medicines you take. The following interactions are of particular clinical importance:

• Verapamil and diltiazem: combined use with nebivolol can cause excessive slowing of the heart rate and conduction problems. This combination is generally not recommended.
• Other antihypertensive medicines: additive blood pressure lowering effects should be considered.
• Antiarrhythmic medicines such as amiodarone: combined use may further slow heart rate or cause conduction abnormalities.
• CYP2D6 inhibitors including fluoxetine, paroxetine, bupropion, and some antipsychotics: these can increase nebivolol blood levels significantly. Your prescriber will factor this into their assessment.
• Insulin and oral antidiabetic medicines: nebivolol may mask some hypoglycaemia warning signs such as fast heart rate in patients with diabetes. Blood glucose monitoring remains important.
• Clonidine: if both medicines are being stopped, nebivolol should be discontinued several days before clonidine to reduce the risk of rebound hypertension.

Your prescriber will review all current medicines during the clinical assessment before any prescription is considered.

Nebivolol is a Prescription Only Medicine. The clinical consultation is the essential first step. A prescription will only be issued if a registered prescriber concludes, based on their individual assessment of your circumstances, that nebivolol is clinically appropriate for you.

During your online consultation with Pharmacy Planet, a registered prescriber will review the information you provide. This includes your blood pressure or heart failure diagnosis, your heart rate, respiratory history, current medicines, liver function where relevant, and other aspects of your medical history. For hypertension, the prescriber will assess whether nebivolol is an appropriate antihypertensive medication for your situation. For heart failure repeat prescriptions, the prescriber will review whether the online route is appropriate given the specialist nature of this indication.

If you are under the care of a cardiologist or heart failure specialist for any of the conditions nebivolol is used to treat, please keep them informed of all medicines prescribed through online services. Coordinated care supports the safest approach to BP regulation, heart rate control, and cardiovascular therapy.

• Store below 30°C.
• Store in the original packaging to protect from moisture and light.
• Keep out of the sight and reach of children.
• Do not use after the expiry date printed on the packaging.
• Do not dispose of medicines via household waste or wastewater. Return unused or out of date tablets to your pharmacist for safe disposal.
• Full storage instructions are provided in the Patient Information Leaflet supplied with your medicine.

The table below compares beta blocker tablets available at Pharmacy Planet. Beta blockers reduce heart rate and cardiac output to lower blood pressure. They differ in cardioselectivity, additional properties, and licensed indications.

Important: This comparison is for general information only and does not replace medical advice. A prescriber will decide which treatment is suitable for you following an online consultation.

Pharmacy Planet is a GPhC-registered online pharmacy providing access to prescription medicines through a clinically led consultation process. Our registered prescribers and pharmacists are committed to patient safety, clinical accuracy, and responsible prescribing.

We follow GPhC standards, MHRA guidance, and ASA advertising regulations in all aspects of our service. Every prescription is reviewed and dispensed by qualified healthcare professionals. We provide clear, factual information to help patients understand their antihypertensive medication and make informed decisions about their cardiovascular therapy and heart health.

If you have questions about nebivolol or any other medicine, our pharmacy team is available to help. We are committed to transparent, patient centred care.

References

1. Electronic Medicines Compendium (eMC). Nebivolol 2.5 mg, 5 mg and 10 mg tablets — Summary of Product Characteristics. https://www.medicines.org.uk/emc. Accessed May 2026.
2. National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management. NICE guideline NG136. https://www.nice.org.uk/guidance/ng136. Accessed May 2026.
3. National Institute for Health and Care Excellence (NICE). Chronic heart failure in adults: diagnosis and management. NICE guideline NG106. https://www.nice.org.uk/guidance/ng106. Accessed May 2026.
4. NHS. High blood pressure (hypertension). https://www.nhs.uk/conditions/high-blood-pressure-hypertension. Accessed May 2026.
5. Joint Formulary Committee. British National Formulary (BNF). Nebivolol hydrochloride. BMJ Group and Pharmaceutical Press. https://bnf.nice.org.uk. Accessed May 2026.
6. Medicines and Healthcare products Regulatory Agency (MHRA). Yellow Card — report a side effect. https://yellowcard.mhra.gov.uk. Accessed May 2026.