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Just a quick run down on Nebivolol, it’s a 3rd gen beta blocker that is highly selective and only blocks the Beta-1 receptor unlike the classic beta blockers. This means your heart rate can still rise to a healthy degree with high intensity exercise. It’s also special because it relaxes the Aortic Valve which other beta blockers do not. Long story short, you don’t want a stiff aortic valve. It can also lower heart rate by roughly 15 beats per 5mg and will decrease bp by roughly 10-15%
Pharmacodynamics
Nebivolol is a selective beta-1 adrenergic receptor antagonist that decreases vascular resistance, increases stroke volume and cardiac output, and does not negatively affect left ventricular function.2,3 It has a long duration of action as effects can be seen 48 hours after stopping the medication and a wide therapeutic window as patients generally take 5-40mg daily.2,9 Patients should not abruptly stop taking this medication as this may lead to exacerbation of coronary artery disease.9 Diabetic patients should monitor their blood glucose levels as beta blockers may mask signs of hypoglycemia.9
Mechanism of action
Nebivolol is a highly selective beta-1 adrenergic receptor antagonist2 with weak beta-2 adrenergic receptor antagonist activity.3 Blocking beta-1 adrenergic receptors by d-nebivolol leads to decreased resting heart rate, exercise heart rate, myocardial contracility, systolic blood pressure, and diastolic blood pressure.4,2,3,5 The selectivity of d-nebivolol limits the magnitude of beta blocker adverse effects in the airways or relating to insulin sensitivity.5 Nebivolol also inhibits aldosterone, and beta-1 antagonism in the juxtaglomerular apparatus also inhibits the release of renin.5 Decreased aldosterone leads to decreased blood volume, and decreased renin leads to reduced vasoconstriction.5 l-nebivolol is responsible for beta-3 adrenergic receptor agonist activity that stimulates endothelial nitric oxide synthase, increasing nitric oxide levels; leading to vasodilation, decreased peripheral vascular resistance, increased stroke volume, ejection fraction, and cardiac output.1,4,2,3,5 The vasodilation, reduced oxidative stress, and reduced platelet volume and aggregation of nebivolol may lead to benefits in heart failure patients.4
Absorption
The absorption of nebivolol is not affected by food.9 Nebivolol has a Tmax of 1.5-4 hours.9Bioavailability can range from 12-96% for extensive to poor CYP2D6 metabolizers.6,7 For a 20mg dose, d-nebivolol has a Cmax of 2.75±1.55ng/mL, l-nebivolol has a Cmax of 5.29±2.06ng/mL, both enantiomers have a Cmax of 8.02±3.47ng/mL, and nebivolol glucuronides have a Cmax of 68.34±44.68ng/mL.6 For a 20mg dose, d-nebivolol has an AUC of 13.78±15.27ng*h/mL, l-nebivolol has an AUC of 27.72±15.32ng*h/mL, both enantiomers have an AUC of 41.50±29.76ng*h/mL, and nebivolol glucuronides have an AUC of 396.78±297.94ng*h/mL.6
Volume of distribution
For a 20mg dose, d-nebivolol has an apparent volume of distribution of 10,290.81±3911.72L, l-nebivolol has an apparent volume of distribution of 8,066.66±4,055.50L, and both enantiomers together have a volume of distribution of 10,423.42±6796.50L.6
Protein binding
Nebivolol is 98% bound to plasma proteins, mostly to serum albumin.9
Metabolism
Nebivolol is metabolized mainly by glucuronidation and CYP2D6 mediated hydroxylation.1,4 Metabolism involves n-dealkylation, hydroxylation, oxidation, and glucuronidation.7 Aromatic hydroxyl and acyclic oxide metabolites are active, while n-dealkylated and glucuronides are inactive.7
Pharmacodynamics
Nebivolol is a selective beta-1 adrenergic receptor antagonist that decreases vascular resistance, increases stroke volume and cardiac output, and does not negatively affect left ventricular function.2,3 It has a long duration of action as effects can be seen 48 hours after stopping the medication and a wide therapeutic window as patients generally take 5-40mg daily.2,9 Patients should not abruptly stop taking this medication as this may lead to exacerbation of coronary artery disease.9 Diabetic patients should monitor their blood glucose levels as beta blockers may mask signs of hypoglycemia.9
Mechanism of action
Nebivolol is a highly selective beta-1 adrenergic receptor antagonist2 with weak beta-2 adrenergic receptor antagonist activity.3 Blocking beta-1 adrenergic receptors by d-nebivolol leads to decreased resting heart rate, exercise heart rate, myocardial contracility, systolic blood pressure, and diastolic blood pressure.4,2,3,5 The selectivity of d-nebivolol limits the magnitude of beta blocker adverse effects in the airways or relating to insulin sensitivity.5 Nebivolol also inhibits aldosterone, and beta-1 antagonism in the juxtaglomerular apparatus also inhibits the release of renin.5 Decreased aldosterone leads to decreased blood volume, and decreased renin leads to reduced vasoconstriction.5 l-nebivolol is responsible for beta-3 adrenergic receptor agonist activity that stimulates endothelial nitric oxide synthase, increasing nitric oxide levels; leading to vasodilation, decreased peripheral vascular resistance, increased stroke volume, ejection fraction, and cardiac output.1,4,2,3,5 The vasodilation, reduced oxidative stress, and reduced platelet volume and aggregation of nebivolol may lead to benefits in heart failure patients.4
| TARGET | ACTIONS | ORGANISM |
|---|---|---|
| ABeta-1 adrenergic receptor | antagonist | Humans |
| UBeta-2 adrenergic receptor | antagonist | Humans |
| UBeta-3 adrenergic receptor | agonist | Humans |
The absorption of nebivolol is not affected by food.9 Nebivolol has a Tmax of 1.5-4 hours.9Bioavailability can range from 12-96% for extensive to poor CYP2D6 metabolizers.6,7 For a 20mg dose, d-nebivolol has a Cmax of 2.75±1.55ng/mL, l-nebivolol has a Cmax of 5.29±2.06ng/mL, both enantiomers have a Cmax of 8.02±3.47ng/mL, and nebivolol glucuronides have a Cmax of 68.34±44.68ng/mL.6 For a 20mg dose, d-nebivolol has an AUC of 13.78±15.27ng*h/mL, l-nebivolol has an AUC of 27.72±15.32ng*h/mL, both enantiomers have an AUC of 41.50±29.76ng*h/mL, and nebivolol glucuronides have an AUC of 396.78±297.94ng*h/mL.6
Volume of distribution
For a 20mg dose, d-nebivolol has an apparent volume of distribution of 10,290.81±3911.72L, l-nebivolol has an apparent volume of distribution of 8,066.66±4,055.50L, and both enantiomers together have a volume of distribution of 10,423.42±6796.50L.6
Protein binding
Nebivolol is 98% bound to plasma proteins, mostly to serum albumin.9
Metabolism
Nebivolol is metabolized mainly by glucuronidation and CYP2D6 mediated hydroxylation.1,4 Metabolism involves n-dealkylation, hydroxylation, oxidation, and glucuronidation.7 Aromatic hydroxyl and acyclic oxide metabolites are active, while n-dealkylated and glucuronides are inactive.7
- Nebivolol
