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| __NOTOC__
| | #REDIRECT [[Nebivolol#Warnings]] |
| {{Nebivolol}}
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| {{CMG}}; {{AE}} {{SS}}
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| ==Warnings and Precautions==
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| ===Abrupt Cessation of Therapy===
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| Do not abruptly discontinue BYSTOLIC therapy in patients with coronary artery disease. Severe exacerbation of [[angina]], [[myocardial infarction]] and ventricular arrhythmias have been reported in patients with coronary artery disease following the abrupt discontinuation of therapy with [[β-blocker]]s. [[myocardial infarction]] and ventricular arrhythmias may occur with or without preceding exacerbation of the [[angina]] pectoris. Caution patients without overt coronary artery disease against interruption or abrupt discontinuation of therapy. As with other [[β-blocker]]s, when discontinuation of BYSTOLIC is planned, carefully observe and advise patients to minimize physical activity. Taper BYSTOLIC over 1 to 2 weeks when possible. If the [[angina]] worsens or acute coronary insufficiency develops, re-start BYSTOLIC promptly, at least temporarily.
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| ===[[angina]] and Acute [[myocardial infarction]]===
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| BYSTOLIC was not studied in patients with [[angina]] pectoris or who had a recent [[MI]].
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| ===[[bronchospastic]] Diseases===
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| In general, patients with [[bronchospastic]] diseases should not receive [[β-blocker]]s.
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| ===Anesthesia and Major Surgery===
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| Because beta-blocker withdrawal has been associated with an increased risk of mi and [[chest pain]], patients already on beta-blockers should generally continue treatment throughout the perioperative period. If BYSTOLIC is to be continued perioperatively, monitor patients closely when anesthetic agents which depress myocardial function, such as ether, [[cyclopropane]], and [[trichloroethylene]], are used. If β-blocking therapy is withdrawn prior to major surgery, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
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| The β-blocking effects of BYSTOLIC can be reversed by β-agonists, e.g., [[dobutamine]] or [[isoproterenol]]. However, such patients may be subject to protracted severe [[hypotension]]. Additionally, difficulty in restarting and maintaining the heartbeat has been reported with [[β-blocker]]s.
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| ===Diabetes and [[hypoglycemia]]===
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| [[β-blocker]]s may mask some of the manifestations of [[hypoglycemia]], particularly tachycardia. Nonselective [[β-blocker]]s may potentiate insulin-induced [[hypoglycemia]] and delay recovery of serum glucose levels. It is not known whether nebivolol has these effects. Advise patients subject to spontaneous [[hypoglycemia]] and diabetic patients receiving insulin or oral hypoglycemic agents about these possibilities.
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| ===Thyrotoxicosis===
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| [[β-blocker]]s may mask clinical signs of [[hyperthyroidism]], such as tachycardia. Abrupt withdrawal of [[β-blocker]]s may be followed by an exacerbation of the symptoms of [[hyperthyroidism]] or may precipitate a thyroid storm.
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| ===Peripheral Vascular Disease===
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| [[β-blocker]]s can precipitate or aggravate symptoms of arterial insufficiency in patients with [[peripheral vascular disease]].
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| ===Non-dihydropyridine Calcium Channel Blockers===
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| Because of significant negative inotropic and chronotropic effects in patients treated with [[β-blocker]]s and [[calcium channel blockers]] of the [[verapamil]]and [[diltiazem]] type, monitor the ECG and blood pressure in patients treated concomitantly with these agents.
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| ===Use with CYP2D6 Inhibitors===
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| Nebivolol exposure increases with inhibition of CYP2D6 [see Drug Interactions (7)]. The dose of BYSTOLIC may need to be reduced. | |
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| ===Impaired Renal Function===
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| Renal clearance of nebivolol is decreased in patients with severe renal impairment. BYSTOLIC has not been studied in patients receiving dialysis [see Clinical Pharmacology (12.4) and Dosage and Administration (2.1)].
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| === Impaired Hepatic Function===
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| Metabolism of nebivolol is decreased in patients with moderate hepatic impairment. BYSTOLIC has not been studied in patients with severe hepatic impairment [see Clinical Pharmacology (12.4) and Dosage and Administration (2.1)].
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| ===Risk of Anaphylactic Reactions===
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| While taking [[β-blocker]]s, patients with a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge. Such patients may be unresponsive to the usual doses of [[epinephrine]] used to treat allergic reactions.
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| ===[[Pheochromocytoma]]===
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| In patients with known or suspected [[pheochromocytoma]], initiate an α-blocker prior to the use of any [[β-blocker]].<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = BYSTOLIC (NEBIVOLOL HYDROCHLORIDE) TABLET [FOREST LABORATORIES, INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=8b8ad213-1dc8-454e-a524-075685c0e1a8 | publisher = | date = | accessdate = 4 February 2014 }}</ref></div>
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| ==References==
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| {{Reflist|2}}
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| [[Category:Beta blockers]]
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| [[Category:Cardiovascular Drugs]]
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| [[Category:Drugs]]
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