====== Nebivolol ======

Nebivolol is a 3rd-generation, highly β1-selective beta-blocker with nitric oxide–mediated vasodilatory effects.

Unlike [[cardio:beta_blockers:carvedilol|Carvedilol]] or [[cardio:beta_blockers:labetalol|Labetalol]], nebivolol does NOT block alpha-1 receptors.

Classification:
• 3rd Generation (Vasodilating)
• Highly β1 selective
• Nitric oxide–mediated vasodilation
• No intrinsic sympathomimetic activity (ISA)

→ [[cardio:beta_blockers:start|Beta-Blockers Overview]]

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===== Mechanism of Action =====

Blocks:

• β1 receptors → ↓ Heart rate, ↓ contractility, ↓ renin

Additionally:

• Stimulates endothelial nitric oxide release
• Causes vasodilation
• Lowers systemic vascular resistance

Net Effects:

• ↓ Cardiac output
• ↓ SVR
• ↓ Blood pressure

This combination makes nebivolol both cardioselective and vasodilatory.

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===== Indications =====

==== Hypertension ★ ====

• Approved for primary hypertension
• Well tolerated
• Often chosen for younger patients

→ [[cardio:hypertension:start|Hypertension Module]]

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==== Heart Failure ====

• Not a guideline-directed mortality-reducing agent in U.S. guidelines
• Some European data (SENIORS trial) suggests benefit in elderly patients

Primary mortality agents remain:

• [[cardio:beta_blockers:carvedilol|Carvedilol]]
• [[cardio:beta_blockers:metoprolol|Metoprolol Succinate]]
• [[cardio:beta_blockers:bisoprolol|Bisoprolol]]

→ [[cardio:heart_failure:start|Heart Failure Module]]

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===== Advantages =====

• Highly β1 selective
• Lower bronchospasm risk
• Less metabolic disturbance
• Vasodilation without alpha-1 blockade
• Lower incidence of erectile dysfunction (compared to older agents)

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===== Adverse Effects =====

• Bradycardia
• Hypotension
• Fatigue
• Dizziness

Less CNS penetration than highly lipophilic agents like [[cardio:beta_blockers:propranolol|Propranolol]].

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===== Contraindications =====

• Severe bradycardia
• High-grade AV block (without pacemaker)
• Cardiogenic shock
• Acute decompensated heart failure

Use caution in:
• Severe hepatic impairment
• Hypotension

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===== Nebivolol vs Other 3rd-Generation Agents =====

[[cardio:beta_blockers:carvedilol|Carvedilol]]:
• Alpha-1 blockade
• Mortality benefit in HFrEF

[[cardio:beta_blockers:labetalol|Labetalol]]:
• Alpha-1 blockade
• Used in hypertensive emergencies and pregnancy

Nebivolol:
• NO-mediated vasodilation
• Highly β1 selective
• Primarily used for hypertension

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===== Clinical Pearls =====

✔ 3rd-generation vasodilating beta-blocker  
✔ Highly β1 selective  
✔ Vasodilation via nitric oxide  
✔ Not core HFrEF mortality agent  
✔ Often better tolerated metabolically  

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Related:

→ [[cardio:beta_blockers:start|Beta-Blockers Overview]]
→ [[cardio:hypertension:start|Hypertension Module]]
→ [[cardio:heart_failure:start|Heart Failure Module]]
→ [[cardio:intro:start|Return to Cardiovascular Modules]]