Bystolic (Nebivolol) - Oral

What Is Bystolic?

Bystolic (nebivolol) is a prescription medication that is used as a treatment option for hypertension (high blood pressure). This medication is a beta-blocker that is thought to lower blood pressure by:

  • Slowing down the heart rate
  • Relaxing the blood vessels
  • Lessening how hard the heart contracts (squeezes)
  • Blocking renin—a type of protein in the renin-angiotensin system (RAS) that raises blood pressure 
  • Affecting the vasomotor center—a part of the brain that influences blood pressure

Bystolic is available as an oral tablet.

Drug Facts

Generic Name: Bystolic

Brand Name: Nebivolol

Drug Availability: Prescription 

Therapeutic Classification: Antihypertensive

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Oral 

Active Ingredient: Nebivolol hydrochloride 

Dosage Form(s): Oral tablet

What Is Bystolic Used For?

The Food and Drug Administration (FDA) approved Bystolic to treat hypertension—a blood pressure measurement with the top number higher than 130 millimeters of mercury (mm Hg) or the bottom number over 80 millimeters of mercury.

About 50% of adults have high blood pressure or take an antihypertensive medication in the United States (U.S.), but only one-fourth of these adults have well-controlled blood pressure. When uncontrolled, this medical condition raises the likelihood of a heart attack or stroke, which are the leading causes of death in the U.S.

Although Bystolic is a treatment option for high blood pressure, it’s a beta-blocker. In general, beta-blockers are not the go-to option for hypertension unless you also have other heart-related medical conditions. These other heart conditions include heart failure (HF) or ischemic heart disease (IHD), also known as angina.

How to Take Bystolic

Take Bystolic once daily with or without food. To help you remember, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your healthcare provider to explain any questions. Do not take more or less of it or take it more often than prescribed by your healthcare provider.

Storage

With Bystolic being a non-controlled prescription medication, your healthcare provider can give you refills for up to one year from the originally written date on the prescription.

If you’re just starting Bystolic or if you’re changing Bystolic doses, however, your healthcare provider might give you fewer refills to monitor your blood pressure and Bystolic side effects. Once you’re on a dose that helps lower your blood pressure with few side effects, your healthcare provider will authorize more refills.

Once you bring Bystolic home from the pharmacy, store the medication between 68 F to 77 F in a secure, dry location away from children or pets.

If you would like to travel with Bystolic, become familiar with your final destination’s regulations. In general, you may need a copy of your Bystolic prescription. Also, try to keep the medication in its original container—with your name on it—from the pharmacy.

Off-Label Uses

As previously mentioned, experts recommend beta-blockers for IHD or HF. Experts also recommend beta-blockers after a heart attack. However, Toprol XL (metoprolol), or Coreg (carvedilol), is the typically preferred beta-blockers for all of these medical conditions—not Bystolic

How Long Does Bystolic Take to Work?

Within two weeks of treatment with Bystolic, you should notice lower blood pressure numbers.

What Are the Side Effects of Bystolic?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

As with all medications, Bystolic can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.

Common Side Effects

Common side effects with Bystolic include:

Severe Side Effects

If any of the common side effects bother you or won’t go away, let your healthcare provider know.

Get medical help right away if you experience the following serious side effects:

Also, if you have diabetes, closely monitor your blood sugar. Bystolic can mask many symptoms of hypoglycemia (low blood sugar).

Long-Term Side Effects

While many people tolerate Bystolic well, long-term or delayed side effects are possible. Some long-term side effects can be mild,

In people with hyperthyroidism, stopping Bystolic can worsen their overactive thyroid condition and cause a thyroid storm, which is a life-threatening situation. In general, discontinuing Bystolic is also linked to angina, heart attack, or abnormal heart rhythm.

Don’t stop Bystolic without talking with your healthcare provider first. If you and your healthcare provider decide to stop Bystolic, don’t suddenly discontinue this medication. Slowly lowering the dose to stop taking Bystolic over one to two weeks may prevent these worrisome side effects.

Report Side Effects

Bystolic may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Bystolic Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For high blood pressure:
      • Adults—At first, 5 milligrams (mg) once a day. Your doctor may increase your dose if needed.
      • Children—Use and dose must be determined by your doctor.

Modifications

Users should be aware of the following before starting Bystolic:

Severe allergic reaction: Avoid using Bystolic if you have a known allergy to it or any of its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Bystolic in children: There are no Bystolic studies in children. However, there are some concerns about possible long-term fertility and developmental effects on children.

People with liver impairment: If you have moderate liver impairment, your healthcare provider will start you at a low dose of 2.5 milligrams of Bystolic and slowly adjust accordingly. If you have severe liver impairment, however, the manufacturer—Allergan—doesn’t recommend taking Bystolic.

Renal dosing: People with a CrCl (creatinine clearance level) <30 milliliter/minute should be started on a lower dose.

Pregnant or nursing parents: Taking beta-blockers during the third trimester of pregnancy may have some negative effects on newborn babies. As a result, the healthcare provider will closely monitor the newborn babies for low blood pressure, low heart rate, low blood sugar, and slow breathing rate.

As for nursing, there is little safety and effectiveness data in nursing babies. Due to the potential negative effects on nursing babies, however, Allergan recommends avoiding Bystolic when nursing.

People who smoke: Smoking can lower Bystolic’s effectiveness. Therefore, try to stop smoking before starting Bystolic, and avoid smoking while taking the medication. Your healthcare provider can help you with this goal.

Missed Dose

If you forget to take a dose, take it as soon as you remember. If it’s close to your next scheduled dose, then skip the missed dose and take the following dose at your next scheduled time. Don’t try to double up and take more than one dose to make up for the missed dose.

If you miss too many doses in a row, you might experience severe discontinuation side effects—like chest pain, heart attack, or irregular heart rhythm.

Overdose: What Happens If I Take Too Much Bystolic?

Do not take more Bystolic than directed on the package label. If you accidentally took too many Bystolic tablets, you may experience the following side effects.

If you experience these symptoms of an overdose, seek immediate medical attention.

What Happens If I Overdose on Bystolic?

If you think you or someone else may have overdosed on Bystolic, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Bystolic, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects.

Do not interrupt or stop using this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery.

Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.

This medicine may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking nebivolol.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Bystolic?

Bystolic is not appropriate for everyone. You should not take this medication if you are allergic to acetaminophen or any of the inactive ingredients in Bystolic.

You should avoid Bystolic if you have the following:

  • Allergic reaction: If you’re allergic to Bystolic or its components, don’t take Bystolic.
  • Severe bradycardia: Severe bradycardia is a dangerously slow heart rate. If you take Bystolic, this will further slow down your heart.
  • Heart block greater than the first degree: The electric signals in the heart help control your heartbeat. However, if these signals are blocked, your heart will not beat appropriately. There are three degrees of heart block, with the second and third degrees being more severe.
  • Cardiogenic shock: Although there are different types of shock, all of them are medical emergencies. If you have cardiogenic shock, your heart isn’t pumping enough to meet your body’s needs.  
  • Decompensated heart failure: If you have congestive heart failure (CHF), your heart isn’t filling up with enough blood, or your heart muscle is weak. As a result, your heart isn't pumping enough for your body’s needs. Decompensated CHF is a worsening of your medical condition that will require immediate medical attention.
  • Nursing parents: Due to possible negative effects on the nursing baby, the manufacturer recommends against taking Bystolic while nursing.
  • Sick sinus syndrome without a permanent pacemaker: In a healthy heart, the sinoatrial (SA) node is the natural pacemaker that ensures a steady and regular heartbeat. In people with sick sinus syndrome, however, the damaged SA node can no longer do its job. Therefore, a permanent artificial pacemaker is necessary.
  • Severe liver impairment: The liver is responsible for breaking down Bystolic. If your liver doesn’t work as well as it used to, the higher amounts of Bystolic in your body will raise the risk for serious side effects.

What Other Medications May Interact With Bystolic?

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter (OTC) medicines, and vitamins or supplements. 

Take the following medications with caution:

  • Clonidine: Clonidine is a treatment option for high blood pressure. Combining clonidine and Bystolic raises the risk of serious side effects.
  • CYP2D6-inhibiting medications: CYP2D6 is a type of protein in the liver. CYP2D6 is responsible for breaking down Bystolic. So, if you take a medication that blocks CYP2D6, then the high amounts of Bystolic in your body will raise the likelihood of severe side effects. 
  • Digoxin: Digoxin is a heart-related medication that lowers the heart rate. Combining both medications raises the risk of a very slow rate.
  • Diltiazem or verapamil calcium channel blockers: Diltiazem and verapamil are also heart-related medications. Taking either of these medications with Bystolic may lead to extremely low heart rate, blood pressure, and heart contractions.
  • Reserpine: Reserpine is an option for the treatment of high blood pressure. Taking reserpine with Bystolic raises the likelihood of side effects.

If you have any questions or concerns about these drug interactions, discuss them with your healthcare provider or pharmacist.

What Medications Are Similar?

There are many available beta-blockers. The following beta-blockers are the most similar to Bystolic because they’re also selective at targeting the heart.

  • Tenormin (atenolol)
  • Betaxolol
  • Bisoprolol
  • Toprol XL (metoprolol)

However, Bystolic is still different because it is the only beta-blocker that also relaxes the blood vessels through nitric oxide—a naturally occurring compound in the body.

Although Bystolic is unique, experts don’t typically recommend any beta-blocker as a first-choice option for high blood pressure. Unlike Bystolic, however, experts recommend bisoprolol and Toprol XL metoprolol for other medical conditions—like heart failure.

Since all of these medications are beta-blockers, they are not usually taken together. If you have any questions, talk with your healthcare provider.

Frequently Asked Questions

  • Will Bystolic’s side effects ever go away?

    Many people experience no side effects with beta-blockers. Some people who have side effects from beta-blockers usually feel better with time. If your side effects bother you or don’t go away within a few days, let your healthcare provider know.

  • Why is my heart rate not as high when I exercise?

    Since Bystolic lowers your resting heart rate, the medication will also affect your heart rate during exercise. So, you will probably need to adjust your target heart rate and exercise goals.

  • Do I have to take Bystolic for life?

    The treatment of duration for Bystolic will vary for each individual. Some people will take Benicar for an extended period of time. However, other people are able to achieve their blood pressure goals with a healthy diet and exercise. Before changing your Bystolic dose or stopping this medication, talk with your healthcare provider first. Depending on your particular situation, your healthcare provider will help you with the next steps, which can include continuing Bystolic, lowering the medication dose, or having a small trial period without medication.

How Can I Stay Healthy While Taking Bystolic?

In addition to consistently taking your blood pressure medications—like Bystolic, the following lifestyle changes are also important:

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Ross Phan, PharmD, BCACP, BCGP, BCPS
Ross is a writer for Verywell with years of experience practicing pharmacy in various settings. She is also a board-certified clinical pharmacist and the founder of Off Script Consults.