Bystolic (nebivolol) is a cardioselective beta-blocker that helps lower blood pressure by slowing the heart rate and relaxing blood vessels. Its dual action—beta-1 blockade plus nitric oxide–mediated vasodilation—can lead to steady blood-pressure control with a lower risk of fatigue or sexual side effects compared with some older beta-blockers. It is typically taken once daily and can be used alone or combined with other antihypertensives.
This guide provides a practical, safety-first overview: common uses, Bystolic dosage and directions, precautions, contraindications, possible side effects, drug interactions, what to do if you miss a dose or overdose, how to store the medicine, and U.S. access considerations. It is educational and not a substitute for medical advice from your clinician or pharmacist.
Bystolic (nebivolol) is FDA-approved for the treatment of hypertension in adults. By lowering blood pressure, it helps reduce the risk of cardiovascular complications such as stroke, heart attack, heart failure, and kidney disease. Clinicians may choose Bystolic when patients need a beta-blocker or when other first-line agents (like ACE inhibitors, ARBs, thiazide diuretics, or calcium channel blockers) are not sufficient or not tolerated. Its once-daily dosing and selective beta-1 blockade can be attractive for patients sensitive to fatigue or sexual side effects seen with some nonselective beta-blockers.
While beta-blockers are not the preferred first-line therapy for uncomplicated hypertension in many guidelines, Bystolic is often used when there are compelling indications (such as concurrent arrhythmia or the need for heart rate control) or as part of combination therapy when a single medication does not achieve target blood pressure. Always follow your clinician’s treatment plan and monitoring schedule.
Typical adult starting dose: 5 mg orally once daily, with or without food. Your clinician may titrate the dose every 2 weeks based on response and tolerability to 10 mg, 20 mg, or up to a maximum of 40 mg once daily. Take Bystolic at about the same time each day. If swallowing is difficult, ask your pharmacist whether your specific tablet strength is scored and can be split; do not crush or split unless advised.
Special populations: For patients with severe renal impairment (creatinine clearance below ~30 mL/min) or moderate hepatic impairment, a lower starting dose—often 2.5 mg once daily—is recommended, with cautious titration. Severe hepatic impairment is a contraindication. Older adults may also start at 2.5 mg to minimize bradycardia or dizziness, titrating slowly under supervision.
Administration tips: Do not abruptly stop Bystolic, as sudden beta-blocker withdrawal can trigger angina, a hypertensive surge, or arrhythmia. If discontinuation is needed, your clinician will create a tapering plan over 1–2 weeks while monitoring heart rate and blood pressure. Keep a blood pressure log and note resting heart rate; report persistent readings above target or resting heart rate below about 55 beats per minute with symptoms (lightheadedness, fatigue) to your prescriber.
Respiratory conditions: Although nebivolol is cardioselective, all beta-blockers can potentially worsen bronchospasm. Use caution and close medical supervision if you have asthma or COPD. Report any new wheezing, shortness of breath, or chest tightness promptly.
Diabetes and thyroid: Bystolic may mask some symptoms of hypoglycemia (such as palpitations) and of hyperthyroidism (tachycardia). If you use insulin or sulfonylureas, check blood glucose more frequently when starting or changing dose. If hyperthyroidism is suspected, do not abruptly discontinue a beta-blocker without medical advice.
Cardiac monitoring: Beta-blockers slow the heart. If you develop symptomatic bradycardia, dizziness, fainting, new chest pain, or swelling/shortness of breath suggestive of heart failure exacerbation, seek medical evaluation. People with peripheral vascular disease may notice worsened cold extremities; report changes to your clinician.
Allergies and anaphylaxis: Beta-blockers may reduce the effectiveness of epinephrine used to treat severe allergic reactions; tell your allergist and carry your emergency plan if you have a history of anaphylaxis.
Pregnancy and lactation: Talk to your obstetric provider if you are pregnant, planning to become pregnant, or breastfeeding. Beta-blocker exposure can affect fetal growth and neonatal heart rate and blood sugar; risk–benefit assessment and closer monitoring may be required. Do not start or stop any blood-pressure medication during pregnancy without obstetric guidance.
Driving and alcohol: Dizziness or fatigue can occur, especially when starting therapy or increasing the dose. Use caution with driving or operating machinery until you know how Bystolic affects you. Alcohol may potentiate hypotension; limit consumption.
Do not take Bystolic if you have any of the following unless specifically directed and closely monitored by a cardiologist:
• Severe bradycardia (very slow heartbeat) or sick sinus syndrome without a pacemaker
• Second- or third-degree atrioventricular (AV) block without a pacemaker
• Cardiogenic shock or decompensated heart failure requiring intravenous inotropes
• Severe hepatic impairment
• Known hypersensitivity to nebivolol or any component of the formulation
Relative cautions include severe peripheral arterial disease, untreated pheochromocytoma (must be alpha-blocked first), and baseline hypotension. Your clinician will decide if benefits outweigh risks in these settings.
Common side effects: Headache, fatigue, dizziness, nausea, diarrhea, and insomnia are among the most frequently reported. Some people experience colder hands/feet or mild swelling. Because nebivolol is beta-1 selective and promotes nitric-oxide–mediated vasodilation, it may have a favorable profile regarding sexual function and metabolic effects compared with older beta-blockers, but decreased libido or erectile dysfunction can still occur.
Cardiac effects: Slowed heart rate (bradycardia), low blood pressure, and, rarely, heart block can occur. Notify your clinician if your resting heart rate persistently drops below about 55 bpm with symptoms, or if you experience fainting, worsening shortness of breath, or new chest discomfort.
Respiratory and metabolic: Wheezing or bronchospasm is uncommon but possible—seek care if you notice breathing difficulty. Beta-blockers can mask adrenaline-driven symptoms of low blood sugar; monitor glucose closely if you have diabetes, particularly when changing the dose.
Allergic reactions: Rash, itching, or hives may occur; facial swelling, throat tightness, or difficulty breathing requires emergency attention. Report any severe or persistent side effects. Most mild symptoms improve after the first 1–2 weeks as your body adjusts.
CYP2D6 interactions: Nebivolol is metabolized by CYP2D6. Strong inhibitors—such as fluoxetine, paroxetine, quinidine, propafenone, and bupropion—can increase nebivolol levels and the risk of bradycardia or hypotension; dose adjustments and closer monitoring may be needed. Potent inducers (e.g., rifampin) may reduce effect.
Heart-rate–lowering drugs: Combining Bystolic with certain calcium channel blockers (verapamil, diltiazem), amiodarone, digoxin, or other antiarrhythmics increases the risk of bradycardia or heart block. If such combinations are necessary, clinicians typically start low, monitor ECG/heart rate, and counsel patients about warning symptoms.
Other antihypertensives: Additive blood-pressure lowering occurs with ACE inhibitors, ARBs, thiazides, loop diuretics, alpha-blockers, and clonidine. Particular caution is warranted with clonidine; if both are used, clinicians usually taper the beta-blocker first before tapering clonidine to reduce rebound hypertension risk.
Respiratory and allergy medications: Beta-agonist bronchodilators (such as albuterol) may be less effective when taking beta-blockers; asthma/COPD patients need tailored plans. Beta-blockers may also blunt response to epinephrine for anaphylaxis—ensure emergency providers know you take nebivolol.
Other considerations: NSAIDs (like ibuprofen, naproxen) can attenuate antihypertensive effects; use the lowest effective dose for the shortest duration. Alcohol increases the risk of dizziness or low blood pressure. Anesthetic agents can compound bradycardia/hypotension—inform surgical teams in advance. Always provide your full medication and supplement list to your clinician and pharmacist.
If you miss a dose of Bystolic, take it as soon as you remember the same day. If it is almost time for your next dose, skip the missed dose and resume your normal schedule. Do not take two doses at once to make up for a missed dose. Keeping a daily alarm or pill organizer can help prevent missed doses and maintain steady blood-pressure control.
Symptoms of nebivolol overdose can include profound bradycardia, hypotension, dizziness or fainting, shortness of breath or wheezing, heart block, hypoglycemia, and, in severe cases, shock. If an overdose is suspected, call emergency services immediately. In the U.S., contact Poison Control at 1-800-222-1222 for real-time guidance. Medical teams may use supportive measures such as IV fluids, atropine for bradycardia, glucagon, vasopressors, or beta-agonists as clinically indicated.
Store Bystolic at room temperature, ideally 20–25°C (68–77°F), in a dry place away from direct light and moisture. Keep tablets in the original, tightly closed container and out of reach of children and pets. Do not use past the expiration date. If your home is very humid, consider a cool, dry storage location outside the bathroom. Ask your pharmacist about safe disposal for unused or expired medication.
In the United States, Bystolic (nebivolol) is a prescription-only medication. It must be dispensed pursuant to a valid prescription issued by a licensed clinician after an appropriate medical evaluation. Many adults now fulfill this requirement through telehealth: an online visit with a U.S.-licensed provider who reviews your history, checks for contraindications or interactions, and, if appropriate, sends an electronic prescription to a pharmacy for dispensing and delivery.
Nunzia Pharmaceutical offers a legal, structured pathway often described as “buy Bystolic without prescription” in the sense that you do not need to arrange an in-person, paper prescription in advance. Instead, Nunzia facilitates a compliant telemedicine evaluation by a licensed clinician. If the clinician determines Bystolic is appropriate, they issue a valid prescription, and a partnering pharmacy fulfills the order. This approach maintains all U.S. prescription safeguards while streamlining access for eligible adults.
Important: Avoid overseas or unverified websites that ship “prescription drugs” without any medical review—these may be illegal and unsafe. Whether you use your own doctor, a local clinic, or a vetted telehealth service, ensure a legitimate prescription is on file, your medication is sourced from licensed U.S. pharmacies, and you have ongoing follow-up to track blood pressure, heart rate, and side effects.
Bystolic is the brand name for nebivolol, a highly selective beta-1 blocker that slows the heart rate and reduces the force of contraction while also promoting nitric-oxide–mediated vasodilation, which relaxes blood vessels to lower blood pressure.
Its primary FDA-approved use is treating hypertension in adults; clinicians may also use nebivolol off-label for rate control in certain tachyarrhythmias, but it is not FDA-approved for heart failure in the United States.
Some blood pressure reduction appears within 1–2 weeks, with the full effect typically reached in 2–4 weeks after dose stabilization.
The typical starting dose is 5 mg once daily, taken at the same time each day with or without food; your clinician may titrate every 2 weeks up to 40 mg daily based on blood pressure and heart rate.
In severe renal impairment (creatinine clearance <30 mL/min) many start at 2.5 mg daily; Bystolic is not recommended in severe hepatic impairment, and lower starting doses are used in moderate hepatic impairment—follow prescriber guidance.
Headache, fatigue, dizziness, nausea, constipation, bradycardia, and cold hands or feet are most common; some people notice sleep disturbance or vivid dreams.
Seek care for very slow pulse, fainting, new or worsening shortness of breath or wheezing, swelling of legs, sudden weight gain, severe dizziness, depression, or signs of allergic reaction.
Avoid if you have severe bradycardia, second- or third-degree heart block without a pacemaker, cardiogenic shock, decompensated heart failure, sick sinus syndrome, severe hepatic impairment, or a known hypersensitivity to nebivolol.
Nebivolol is cardioselective, which lowers bronchospasm risk compared with nonselective beta-blockers, but it can still worsen wheezing at higher doses; use caution and close monitoring, especially in moderate-to-severe asthma.
It can mask adrenergic symptoms of hypoglycemia (like tremor and palpitations), so monitor glucose closely; compared with older beta-blockers, nebivolol tends to be more metabolically neutral, but individualized monitoring is still important.
Beta-blockers can blunt exercise heart-rate response; nebivolol is associated with a lower rate of erectile dysfunction than some others due to nitric oxide effects and is generally weight-neutral, though modest weight gain can occur in some patients.
Alcohol can amplify dizziness or low blood pressure, so limit intake; moderate caffeine is acceptable, but nebivolol may blunt the heart-rate effects of caffeine without preventing blood pressure spikes in sensitive individuals.
CYP2D6 inhibitors (such as fluoxetine, paroxetine, quinidine, propafenone) can raise nebivolol levels; combining with other rate-slowing drugs (verapamil, diltiazem, digoxin, amiodarone) can cause bradycardia; be cautious with clonidine (taper beta-blocker last), PDE5 inhibitors, and excessive alcohol; NSAIDs may reduce antihypertensive effect.
If you miss a dose, take it when remembered unless it is close to your next dose—do not double up; never stop abruptly, as rebound hypertension, angina, or arrhythmias can occur—taper over 1–2 weeks with clinician guidance.
Yes; check blood pressure and heart rate at home, and follow up for dose adjustments; your prescriber may periodically assess kidney and liver function and screen for side effects or drug interactions.
Yes, generic nebivolol is available and typically far less expensive than brand-name Bystolic; prices vary by dosage, pharmacy, and insurance coverage.
It is often combined with diuretics, ACE inhibitors, ARBs, or calcium channel blockers for synergistic control; combinations should be tailored and monitored to avoid excessive bradycardia or hypotension.
Beta-blockers may reduce placental perfusion and can cause fetal/neonatal bradycardia or hypoglycemia; use only if benefits outweigh risks under specialist guidance, and discuss breastfeeding, as human data for nebivolol are limited.
Both are beta-1 selective, once-daily options; nebivolol adds nitric oxide–mediated vasodilation and may have a slightly more favorable side-effect profile (fatigue, sexual function, metabolic effects) in some patients, while metoprolol is more extensively studied and widely used.
In the United States, metoprolol succinate has a proven mortality benefit and FDA approval for HFrEF, while nebivolol does not have an HF indication in the US; for heart failure, guideline-directed options like metoprolol succinate, carvedilol, or bisoprolol are preferred.
Atenolol is older, renally cleared, and less lipophilic, with fewer CNS effects but weaker outcome data; nebivolol is highly beta-1 selective, offers vasodilation via nitric oxide, and may have fewer metabolic and sexual side effects, with similar once-daily dosing.
Both lower blood pressure well; carvedilol blocks beta and alpha-1 receptors, which can cause more orthostatic dizziness but may benefit patients with HFrEF; nebivolol is typically better tolerated for pure hypertension with less orthostasis and often less fatigue.
Both are highly beta-1 selective and once-daily; bisoprolol is FDA-approved for HFrEF and widely used in that setting, while nebivolol adds nitric oxide–mediated vasodilation and may have a slight edge in sexual function and peripheral circulation for hypertension.
Propranolol is nonselective, crosses the blood–brain barrier, and is useful for migraine prevention, essential tremor, and performance anxiety; nebivolol is preferred for hypertension in patients needing a cardioselective beta-blocker with fewer CNS effects.
Labetalol (alpha-1 and nonselective beta blockade) is commonly used for hypertensive emergencies and during pregnancy; nebivolol is not first-line in these scenarios but is a solid once-daily option for chronic hypertension outside of pregnancy.
Nadolol is nonselective, very long-acting, and renally eliminated (often requiring dose adjustment); nebivolol is cardioselective with hepatic metabolism via CYP2D6, typically once daily, and may be preferable in patients with reactive airway disease risks.
Acebutolol has intrinsic sympathomimetic activity (partial agonism), which may cause less resting bradycardia but can blunt efficacy in high sympathetic states; nebivolol lacks ISA and provides consistent beta-1 blockade plus vasodilation.
Pindolol is nonselective with intrinsic sympathomimetic activity, which may preserve resting heart rate but is less ideal for hypertension; nebivolol’s selectivity and NO-mediated vasodilation often translate to better BP control and tolerability.
No; esmolol is an ultra–short-acting IV beta-1 blocker for acute arrhythmias or perioperative use, while nebivolol is an oral, long-acting medication for chronic hypertension.
Sotalol is both a nonselective beta-blocker and a class III antiarrhythmic with QT-prolonging effects used for atrial and ventricular arrhythmias; nebivolol is for hypertension and rate control without class III properties.
Head-to-head trials suggest nebivolol achieves comparable or slightly greater BP reductions with potentially fewer adverse metabolic and sexual side effects, though individual response varies.
The active ingredient is the same; most patients do equally well on generic nebivolol, though inert excipients differ—if you notice changes after a switch, discuss with your pharmacist or prescriber.