Bystolic dosage, forms, and strengths

Bystolic is a brand-name prescription drug used to treat high blood pressure. Bystolic’s active ingredient is nebivolol, a third-generation beta blocker that reduces blood pressure by both slowing the heart and decreasing the strength of the heart’s contractions. It also widens blood vessels (vasodilation) through a mechanism different from beta blocking, helping to further reduce blood pressure. 

As a new drug, it is commonly used as a second-line hypertension treatment, but because of its selective effects on the heart and unique vasodilatory mechanism of action, it is often prescribed in people with lung disease, vascular problems, or African Americans who may have problems with other beta blockers. People take Bystolic once per day as a tablet. It makes no difference if the dose of Bystolic is taken with food or on an empty stomach.

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Bystolic forms and strengths

Tablets are the only Bystolic dosage form and are sold in three dosage strengths:

• Tablets: 2.5 milligrams (mg), 5 mg, 10 mg, 20 mg

Bystolic dosage for adults

Bystolic is FDA-approved as an antihypertensive to control high blood pressure in adults. People with high blood pressure are typically started on a 5 mg daily dose, but the dose can be increased after two weeks if a higher dose is needed.

Source: Epocrates

Off-label uses:

• Angina (chest pain)

• Arrhythmias

• Anxiety

• Heart failure

Bystolic dosage for hypertension

The U.S. Food and Drug Administration (FDA) has approved Bystolic only to treat high blood pressure. The active ingredient, nebivolol, is a beta blocker. Drugs in this class work by making the heart beat more slowly and with less force, thus bringing down blood pressure. But nebivolol is a beta blocker with special properties. First, unlike many other beta blockers used for blood pressure, nebivolol almost exclusively affects beta receptors in the heart. Thus, it is called a ‘cardioselective’ beta blocker. This is in contrast to some beta blockers (i.e. propranolol), which also affect beta receptors in other places such as the blood vessels and lungs. Because of these special properties, nebivolol is less likely to cause respiratory side effects such as bronchospasms. The beta blockers found in the lungs are also located in blood vessels. Nonselective beta blockers act on these receptors to widen blood pressure, which can aid their ability to lower blood pressure. Although nebivolol does not act on these receptors (unless a higher dose is used), it has other unique effects on blood vessels Nebivolol promotes the production of a chemical called nitrous oxide (NO) that causes blood vessels to widen (vasodilation) Therefore, nebivolol retains the ability to widen blood vessels without affecting the lungs. For this reason, nebivolol is often used in people who can’t take other vasodilating beta blockers because of lung problems.

• Standard dosage for high blood pressure: 5–40 mg taken orally once per day

• Maximum dosage for high blood pressure: 40 mg per day

Bystolic dosage for children

Bystolic is not FDA-approved for use in children or adolescents younger than 18 years of age.

Bystolic dosage restrictions

Like all prescription drugs, Bystolic may cause problems in some people.

Because of the potential hazards, Bystolic is never prescribed to people with a very slow heartbeat (severe bradycardia), moderate to severe heart block, cardiogenic shock, decompensated heart failure (when heart failure suddenly becomes worse), sick sinus syndrome (if there’s no pacemaker), severe liver disease, or allergies to any of the ingredients in Bystolic. 

People who may have problems taking Bystolic include those with chest pain (angina), recent heart attack, certain types of irregular heartbeats, bronchospastic lung problems (asthma, bronchitis, or emphysema), liver problems, kidney problems, blood circulation problems in the legs, feet, or arms (peripheral vascular disease), diabetes, low blood sugar (hypoglycemia), overactive thyroid (hyperthyroidism or thyrotoxicosis), and a type of adrenal gland cancer (pheochromocytoma), or people who have a history of severe allergic reactions (anaphylaxis). People with any of these conditions will need to be monitored for side effects of Bystolic or other issues before they become serious problems.

Patients who have diabetes mellitus, or who are predisposed to developing diabetes (ie. prediabetic patients), need to be aware of several effects of beta blockers. First, all beta blockers have been shown to increase the risk of developing diabetes in hypertensive patients. Nonselective beta blockers can increase insulin-induced hypoglycemia (low blood sugar). It is not known if nebivolol has this particular effect, since it is cardioselective. All beta blockers, including nebivolol, can mask signs of low blood sugar, such as increased heart rate, palpitations, tremors, and sweating. Therefore, blood sugar must be monitored extra closely if a beta blocker is used.

Nebviolol is broken  down by the liver and eliminated through the kidneys (excreted in urine), so people with liver or kidney problems may need to be started on a lower dose to avoid possible side effects. People who have genes that alter how they metabolize certain drugs (CYP450 2D6 “extensive metabolizers,” “poor metabolizers” or “slow metabolizers”) are generally given the same dose of nebivolol as normal metabolizers.

• Patients with renal impairment (kidney disease): 

  • Severe renal impairment (creatinine clearance less than 30 mL/min): Starting dose 2.5 mg per day

  • Dialysis: Not defined 

• Patients with hepatic impairment (liver disease): 

  • Mild to moderate hepatic impairment (Child-Pugh Class A or B): Starting dose 2.5 mg per day

  • Severe hepatic impairment (Child-Pugh Class C): Contraindication 

Bystolic dosage for pets

As with all human medicines, Bystolic should not be given to animals. Nebivolol is not used or approved for use in animals, though pets may be commonly prescribed beta blockers like metoprolol or propranolol for heart rate problems, high blood pressure, or certain types of heart disease in cats. If a pet has swallowed Bystolic capsules, get immediate veterinary attention by calling a pet poison helpline or contacting a veterinarian.

How to take Bystolic

Each dose of Bystolic is taken by mouth once per day with or without food.

• Take Bystolic every day as directed by a healthcare provider. The dose may need to be changed a few times to find the most effective dose.

• This medicine should come with a patient information insert. This guide has instructions and important drug information about what to watch out for. Please read it before taking the medication.

• Swallow the Bystolic tablet whole. 

• A healthcare provider may prescribe or advise a restricted diet to help control blood pressure. Please follow this diet rigorously to realize the full benefits of Bystolic treatment.

• Store this medicine at room temperature (68°–77° F) using a child-resistant closure.

Bystolic dosage FAQs

How long does it take Bystolic to work?

Nebivolol is rapidly absorbed upon oral administration. A single dose of Bystolic reaches its maximum concentration in one and a half to four hours after being taken. This is when a single dose has its peak effect.  However, prolonged exposure to nebivolol’s effects is needed before blood pressure readings begin to drop. It may take 1-2 weeks before lower blood pressure becomes evident.

How long does Bystolic stay in your system?

With a half-life of 12 to 19 hours—depending on how well the body metabolizes the drug—the effects of Bystolic on the heart and blood pressure can last up to 48 hours after a dose is taken. It can take anywhere from two and a half to five days for the body to completely clear a dose of Bystolic.

What happens if I miss a dose of Bystolic?

If a dose of Bystolic is missed, take it as soon as it’s remembered. However, if it is nearly time for the next dose, skip the missed dose and take the next dose on schedule. Do not take two doses to make up for a missed dose.

How long can you take Bystolic?

Bystolic, like most antihypertensives, is intended for long-term treatment. There is no limit to how long patients can take Bystolic. As long as it works at controlling blood pressure and as long as side effects are tolerable, a healthcare provider may continue to prescribe Bystolic indefinitely.

How do I stop taking Bystolic?

Bystolic and all beta blockers should never be stopped suddenly. In all patients, especially people with coronary artery disease, the sudden discontinuation of a beta blocker could cause chest pain (angina), heart attack, and irregular heartbeats. Because coronary artery disease is often undiagnosed, do not stop taking Bystolic until you get medical advice from a healthcare professional. Physicians will generally advise minimal physical activity while steadily decreasing the dose over one to two weeks before finally discontinuing the treatment.

There are, however, many reasons why people may need to stop taking Bystolic. Severe allergic reactions may require that Bystolic be stopped immediately. Other people may need to stop taking Bystolic because of severe side effects such as heart failure, heart block, severely slow heartbeats (bradycardia), blood vessel problems, or airway closure in their lungs. Still, others may have problems living with common side effects of Bystolic such as headache, tiredness, and dizziness.

There is, fortunately, a broad spectrum of medications that can help control high blood pressure. Besides other beta blockers, the list of antihypertensives includes ACE inhibitors, angiotensin-II receptor blockers (ARBs), calcium channel blockers, alpha blockers, and diuretics. Many of these are well-studied drugs with proven safety profiles.

What is the maximum dosage for Bystolic?

The maximum daily dose of Bystolic is 40 mg.

Can you overdose on Bystolic?

Depending on the size of the overdose, taking too much Bystolic could be a medical emergency. Common symptoms of a Bystolic overdose include low blood pressure and slow heart rate, but other possible symptoms include dizziness, tiredness, vomiting, low blood sugar (hypoglycemia), and heart block, airway constriction, and cardiac failure in the worst cases. If an overdose is suspected, get emergency medical care.

What interacts with Bystolic?

Nebivolol affects the heart and, in higher doses, affects other systems, such as the lungs. Some drug interactions can worsen side effects or cause serious problems. For this reason, it is always a good idea to make sure the prescribing healthcare provider knows about all prescription drugs, over-the-counter medicines, and supplements being taken.

To avoid potentially serious drug interactions, the prescribing healthcare provider will particularly need to know about:

• Calcium channel blockers such as diltiazem or verapamil

• Other beta blockers

• Other blood pressure medications, particularly clonidine

• Digitalis medicines such as digoxin

• Certain types of heart rhythm drugs such as disopyramide

• Erectile dysfunction medications such as Viagra (sildenafil)

Some drugs interfere with the liver’s ability to break down nebivolol, increasing the risk and severity of side effects. Classified as CYP2D6 inhibitors—named after the liver enzyme they block—these drugs may require a lower dose of Bystolic to be safe. Some of these drugs are well-known, such as the antidepressants Paxil (paroxetine) and Prozac (fluoxetine), the stomach acid reducer cimetidine, and the heart rate medications quinidine and propafenone.These do not constitute a comprehensive list of all drugs that could interact with nebivolol. Many drug interactions require the specialized knowledge of a doctor, pharmacist, or other healthcare provider to recognize. For medical advice about drug interactions, it is best to consult a doctor or pharmacist and provide a full list of current medications and supplements.

What happens when you mix Bystolic and alcohol?

The FDA and the manufacturer do not prohibit or discourage drinking alcohol when taking Bystolic. Some healthcare professionals, however, will advise against drinking when taking beta blockers like Bystolic. Like Bystolic, alcohol can lower blood pressure, so the combined effect may be to lower blood pressure too much. Conversely, drinking excessively can increase blood pressure, negating the effects of nebivolol.

Is it safe to take Bystolic during pregnancy?

There are no human studies about whether Bystolic is safe to take during pregnancy. Taken during the second or third trimester, however, beta blockers risk causing low blood pressure, slow heart rate, low blood sugar, and trouble breathing in a newborn.

Because there is no research on the presence of nebivolol in human breast milk or its effects on a nursing infant, women who are breastfeeding should consider switching to a different blood pressure drug or discontinuing breastfeeding when taking Bystolic.

Related resources for Bystolic dosages:

• Bystolic, Epocrates

• Bystolic prescribing information, U.S. National Library of Medicine

• Nebivolol, StatPearls

• Nebivolol, a novel beta blocker for hypertension, Pharmacy and Therapeutics

• Nebivolol compound summary, U.S. National Library of Medicine

• Nebivolol - drug summary, Prescriber’s Digital Reference

• Nebivolol in high-risk, obese African Americans with stage 1 hypertension: Effects on blood pressure, vascular compliance, and endothelial function, Journal of Clinical Hypertension