Generic Name and Formulations:
Nebivolol 5mg, valsartan 80mg; tabs.
Indications for BYVALSON:
Initial therapy or if inadequately controlled on valsartan 80mg or nebivolol doses ≤10mg: 1 tab once daily.
Severe bradycardia. Heart block >1st-degree. Cardiogenic shock. Decompensated cardiac failure. Sick sinus syndrome (unless paced). Severe hepatic impairment (Child-Pugh >B). Concomitant aliskiren in patients with diabetes.
Fetal toxicity may develop; discontinue if pregnancy is detected. Hypotension: correct salt/volume depletion prior to initiation. Coronary artery disease, angina, post-MI, arrhythmias: avoid abrupt cessation (taper over 1–2 weeks). Worsening HF or fluid retention; consider diuretics and treat appropriately. Bronchospastic disease. Surgery. Diabetes. Hyperthyroidism. Peripheral vascular disease. Monitor renal function in renal artery stenosis, chronic kidney disease, severe CHF, or volume depletion. Risk of hyperkalemia; discontinue if necessary. Risk of anaphylactic reactions. Pheochromocytoma. Severe renal or moderate hepatic impairment: initial therapy not recommended. Severe hepatic impairment: not recommended. Neonates. Nursing mothers: not recommended.
See Contraindications. Avoid concomitant CYP2D6 inhibitors (eg, quinidine, propafenone, fluoxetine, paroxetine), other beta-blockers. If concomitant with clonidine, discontinue nebivolol for several days before tapering clonidine. Increased risk of bradycardia with concomitant digitalis glycosides; monitor. Concomitant anesthetics (eg, ether, cyclopropane, trichloroethylene), reserpine, guanethidine; monitor closely. β-blockers may mask hypoglycemia; caution with concomitant insulin or antihyperglycemics. Concomitant verapamil or diltiazem (monitor HR, BP), disopyramide (monitor HR, cardiac conduction). Concomitant K+ supplements, K+ sparing diuretics, K+-containing salt substitutes may cause hyperkalemia; monitor. May be antagonized by, and renal toxicity potentiated by, NSAIDs, including selective COX-2 inhibitors (monitor renal function periodically in elderly and/or volume depleted). Dual inhibition of the renin-angiotensin system with ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely, in general, avoid combined use of RAS inhibitors. Concomitant aliskiren in renal impairment (GFR <60mL/min): not recommended. May increase lithium levels; monitor. May be potentiated by inhibitors of OATP1B1 (eg, rifampin, cyclosporine) or MRP2 (eg, ritonavir).
Beta-blocker + angiotensin II receptor blocker (ARB).
Hypotension, hyperkalemia, others; see full labeling.
Psychiatry Advisor Articles
- ACOG Update: Marijuana Use Discouraged During Pregnancy, Breastfeeding
- Continuing Research, Emerging Treatments Hold Promise for Treating Anorexia Nervosa
- Asenapine Prevents Recurrence of Mood Events in Bipolar Disorder
- Depression Profiles in Patients With Type 1 Diabetes vs Type 2 Diabetes
- Purpose, Questions of Social Interaction Lead Physicians to Delay Retirement
- CBT, Acceptance Commitment Therapy Helpful for Those With Chronic Pain
- Suicidal Behavior, Thoughts Associated With Perfectionist Tendencies
- Depression Reduced by Social Belonging, Feelings of Inclusion
- Sleep Disturbance May Be Causal Factor in Psychotic Experiences
- Is Antidepressant Use in Pregnancy Tied to Psychiatric Disorders in Offspring?
- Cardiovascular Risk Management May Slow Neurocognitive Decline in HIV
- Maintenance rTMS for Treatment-Resistant Depression
- New Study Compares Opioid Dependence Relapse Treatments
- Increase Use of Nursing Home for Patients With Cognitive Impairment Category
- Venlafaxine XR Safe, Effective in Treating Generalized Anxiety Disorder