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BYSTOLIC—Effective as add-on therapy

In a 3-month combination study by Neutel et al

BYSTOLIC provided significant additional BP reductions when added to an ACEI, ARB, and/or diuretic7

1.5_AddOn_Therapy_MobileChange From Baseline (mm Hg)-2-10-3-4-5*P<0.001 vs placeboP=0.02 vs placebo ITT LOCFPlaceboBYSTOLIC5 mgBYSTOLIC10 mgBYSTOLIC 20 mg Reductions From Baseline in Mean Sitting DBP and SBP at Trough at 3 Months7-6-7-8-9-10-3.9-2.6-7.1*-8.2*-7.2*-6.0-8.6*-8.6*(n=167)(n=168)(n=166)(n=168)Background Therapy:ACEI, ARB, and/or Diuretic146.5SBP96.4DBPBaseline:144.8 mm HgSBP96.5DBP147.4SBP96.4DBP145.3SBP95.8DBPMean BP at Week 12 for 20 mg dose: 136.2/87.9 (vs 143.9/92.5 for placebo)

Study Design: Results from a U.S. phase III, 3-month, multicenter, randomized, double-blind, parallel-group, placebo-controlled study of BYSTOLIC as add-on therapy for the treatment of mild to moderate hypertension in patients already taking one or two other antihypertensives (ACEI, ARB, and/or diuretic). Primary endpoint was sitting DBP at trough. Mean values at baseline: sitting DBP at trough, 96.3 mm Hg; sitting SBP at trough, 146.0 mm Hg (N=669).

BYSTOLIC achieved a reduction in mean BP after 12 weeks across all doses7

  • Mean BP at week 12 for other doses was 139.2/89.3 mm Hg for 5 mg and 139.3/88.6 mm Hg for 10 mg7

BYSTOLIC was used second-line in 73% of patients studied7

  • Prior to receiving BYSTOLIC, patients were already receiving stable doses of one or two other antihypertensive therapies—ACEI alone, 36%; ARB alone, 19%; diuretic alone, 18%; ACEI/diuretic, 13%; ARB/diuretic, 13%; ACEI/ARB, <1%7

BYSTOLIC achieved significant heart rate reductions when added to an ACEI, ARB, and/or diuretic7

  • When added to an ACEI, ARB, and/or diuretic, BYSTOLIC provided significant heart rate reductions of -6.2 BPM to -9.3 BPM across the 5 mg-20 mg dosing range vs -1.8 BPM for placebo (P<0.001)7

BYSTOLIC Formulary Coverage Tool

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The Basics of BYSTOLIC Video Series

Dr. Henry Punzi discusses how BYSTOLIC can be used in clinical practice and answers other frequently asked questions.

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Important Safety Information


  • BYSTOLIC is contraindicated in patients with severe bradycardia, heart block greater than first degree, cardiogenic shock, decompensated cardiac failure, sick sinus syndrome (unless a permanent pacemaker is in place), severe hepatic impairment (Child-Pugh >B), and in patients who are hypersensitive to any component of this product.

Warnings and Precautions

  • Do not abruptly discontinue BYSTOLIC therapy in patients with coronary artery disease. Severe exacerbation of angina, myocardial infarction, and ventricular arrhythmias have been reported following the abrupt discontinuation of therapy with beta blockers. 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 beta blockers, 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, restart BYSTOLIC promptly, at least temporarily.
  • BYSTOLIC was not studied in patients with angina pectoris or who had a recent MI.
  • In general, patients with bronchospastic diseases should not receive beta blockers.
  • 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 undergoing major surgery. 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 beta-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.

The beta-blocking effects of BYSTOLIC can be reversed by beta agonists, eg, 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 beta blockers.

  • Beta blockers may mask some of the manifestations of hypoglycemia, particularly tachycardia. Advise patients subject to spontaneous hypoglycemia and diabetic patients receiving insulin or oral hypoglycemic agents about these possibilities.
  • Beta blockers may mask clinical signs of hyperthyroidism, such as tachycardia. Abrupt withdrawal of beta blockers in these patients may be followed by an exacerbation of symptoms or may precipitate a thyroid storm.
  • Beta blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease.
  • Because of significant negative inotropic and chronotropic effects in patients treated with beta blockers and calcium channel blockers of the verapamil and diltiazem type, monitor the ECG and blood pressure of patients treated concomitantly with these agents.
  • When BYSTOLIC is co-administered with an inhibitor or an inducer of CYP2D6, monitor patients closely and adjust the nebivolol dose according to blood pressure response. The dose of BYSTOLIC may need to be reduced. When BYSTOLIC is administered with fluoxetine, significant increases in d-nebivolol may be observed (ie, an 8-fold increase in AUC and a 3-fold increase in Cmax for d‑nebivolol).
  • Renal clearance of nebivolol is decreased in patients with severe renal impairment. In patients with severe renal impairment (ClCr less than 30 mL/min) the recommended initial dose is 2.5 mg once daily; titrate up slowly if needed. BYSTOLIC has not been studied in patients receiving dialysis.
  • Metabolism of nebivolol is decreased in patients with moderate hepatic impairment. In patients with moderate hepatic impairment, the recommended initial dose is 2.5 mg once daily; titrate up slowly if needed. BYSTOLIC has not been studied in patients with severe hepatic impairment and therefore it is not recommended in that population.
  • Patients with a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated challenge and may be unresponsive to the usual doses of epinephrine while taking beta blockers.
  • In patients with known or suspected pheochromocytoma, initiate an alpha blocker prior to the use of any beta blocker.

Adverse Reactions

  • The most common adverse events with BYSTOLIC versus placebo (approximately ≥1% and greater than placebo) were headache, fatigue, dizziness, diarrhea, nausea, insomnia, chest pain, bradycardia, dyspnea, rash, and peripheral edema. The most common adverse events that led to discontinuation of BYSTOLIC were headache (0.4%), nausea (0.2%), and bradycardia (0.2%).

Drug Interactions

  • Use caution when BYSTOLIC is co-administered with CYP2D6 inhibitors (quinidine, propafenone, fluoxetine, paroxetine, etc).
  • Do not use BYSTOLIC with other beta blockers.
  • Both digitalis glycosides and beta blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.
  • BYSTOLIC can exacerbate the effects of myocardial depressants or inhibitors of AV conduction, such as certain calcium antagonists (particularly of the phenylalkylamine [verapamil] and benzothiazepine [diltiazem] classes), or antiarrhythmic agents, such as disopyramide.

Use in Specific Populations

  • BYSTOLIC is not recommended during nursing.
  • In a placebo-controlled trial of 2128 patients (1067 BYSTOLIC, 1061 placebo) over 70 years of age with chronic heart failure receiving a maximum dose of 10 mg per day for a median of 20 months, no worsening of heart failure was reported with nebivolol compared to placebo. However, if heart failure worsens consider discontinuation of BYSTOLIC.

Please see full Prescribing Information.