Common use
Bystolic (nebivolol) is a cardioselective beta-1 blocker used to treat high blood pressure in adults. By blocking beta-1 receptors in the heart, it slows the heart rate and reduces the force of contraction, lowering blood pressure and helping the heart work more efficiently. Nebivolol also promotes vasodilation through nitric oxide pathways, which can further decrease vascular resistance. Lowering high blood pressure reduces the risk of stroke, heart attack, heart failure, and other cardiovascular complications when taken consistently and paired with lifestyle changes such as reduced sodium intake, weight management, and regular physical activity as directed by a clinician.
Bystolic may be used alone or in combination with other antihypertensive medications, including ACE inhibitors, ARBs, diuretics, and calcium channel blockers. Because hypertension often requires multi-drug therapy, clinicians may add Bystolic when additional heart rate control or beta-blockade is desirable. It is not a rescue medication and does not treat acute hypertensive emergencies.
While beta-blockers are occasionally used off-label for other cardiovascular conditions, in the U.S. Bystolic’s primary approved indication is the management of hypertension. Any off-label use should be determined by a licensed healthcare professional who can individualize therapy based on your medical history, coexisting conditions, and concurrent medications.
Dosage and direction
The typical adult starting dose of Bystolic is 5 mg taken once daily, with or without food, at the same time each day. Depending on blood pressure response and heart rate, the dose may be titrated at intervals of approximately two weeks. Usual maintenance dosing ranges from 5 mg to 40 mg once daily. Your prescriber will choose the lowest effective dose to meet your blood pressure goals while minimizing side effects.
For patients with moderate hepatic impairment or significant renal impairment, a lower starting dose and slower titration may be needed. Older adults may also require cautious dose adjustments. Never change your dose or stop Bystolic abruptly without medical guidance; sudden discontinuation can cause rebound hypertension, accelerated angina, or, rarely, precipitate cardiac events in susceptible individuals. If Bystolic must be discontinued, your clinician will typically taper it gradually over one to two weeks.
Monitor your blood pressure and heart rate regularly at home, particularly during the first weeks of therapy and after any dose change. Notify your healthcare professional if your resting heart rate is persistently below the target set by your clinician (often below 60 beats per minute) or if you experience symptoms such as fainting, severe dizziness, or worsening shortness of breath.
Bystolic can be taken with many other blood pressure medicines. If you are starting Bystolic while already taking other beta-blockers or heart-rate–lowering agents (for example, diltiazem, verapamil, or amiodarone), your clinician may adjust doses and monitor more closely for bradycardia or conduction issues.
Precautions
Respiratory conditions: Although nebivolol is relatively beta-1 selective, caution is advised in people with asthma, chronic obstructive pulmonary disease (COPD), or a history of bronchospasm. Beta-blockers can still provoke bronchospasm at higher doses or in sensitive individuals. Discuss inhaler use and asthma control with your clinician before starting Bystolic.
Diabetes and thyroid disorders: Bystolic may mask some adrenergic symptoms of hypoglycemia (such as palpitations and tremor) and hyperthyroidism. People with diabetes should monitor glucose closely and be alert for non-adrenergic signs of low blood sugar, like sweating or confusion. In uncontrolled hyperthyroidism, beta-blockers may be useful symptomatically but should never replace appropriate disease treatment.
Cardiac conduction and circulation: Use caution if you have a history of bradycardia, first-degree atrioventricular (AV) block, sick sinus syndrome, or peripheral vascular disease (which may manifest as cold hands/feet or leg pain with walking). Report new or worsening symptoms such as dizziness, near-syncope, fatigue, or claudication. If you are scheduled for surgery, inform your anesthesiologist that you take Bystolic; certain anesthetics and intraoperative management decisions may be influenced by beta-blocker therapy.
Pregnancy and lactation: Data in pregnancy are limited. Beta-blockers have been associated with fetal growth restriction and neonatal effects in some cases. If you are pregnant, planning to become pregnant, or breastfeeding, discuss risks and benefits with your prescriber to determine the safest regimen for blood pressure control.
Psychiatric effects and fatigue: Some people report fatigue, sleep disturbances, or mood changes while on beta-blockers. If these symptoms emerge and affect quality of life, your clinician can reassess dose or consider alternatives.
Contraindications
Do not use Bystolic if you have any of the following unless explicitly directed by a specialist: severe bradycardia; greater-than-first-degree AV block or sick sinus syndrome without a functioning pacemaker; cardiogenic shock; decompensated heart failure requiring inotropic support; severe hepatic impairment; or known hypersensitivity to nebivolol or any tablet component.
Clinicians will carefully assess risks and benefits if you have symptomatic hypotension, severe peripheral circulatory disorders, or a history of severe bronchospasm. For patients stabilized on chronic beta-blocker therapy who develop acute decompensated heart failure, management should be individualized and may include temporary dose adjustment under close supervision.
Possible side effects
Common side effects include headache, fatigue, dizziness, bradycardia (slow heart rate), nausea, and diarrhea. Many effects are mild and tend to improve as your body adjusts over the first few weeks. Taking the medication at the same time daily and rising slowly from sitting or lying positions can help reduce lightheadedness.
Less common effects may include insomnia, depression, cold extremities, shortness of breath, or sexual dysfunction. Contact your healthcare professional if these are persistent or troublesome. People with underlying lung disease should promptly report wheezing or new breathing difficulties.
Serious reactions are rare but require immediate medical attention: fainting, severe dizziness, chest pain, signs of heart block (very slow or irregular heartbeat), sudden swelling of the face or throat (angioedema), or severe skin reactions. Call emergency services if you experience symptoms of a severe allergic reaction or an acute cardiac event.
Drug interactions
CYP2D6 interactions: Nebivolol is metabolized in part by CYP2D6. Strong inhibitors (for example, fluoxetine, paroxetine, quinidine, bupropion, and propafenone) can raise nebivolol levels, increasing the risk of bradycardia and hypotension. Your clinician may adjust the dose or choose an alternative if you take these agents. Genetic variations in CYP2D6 can also influence nebivolol exposure.
Additive heart-rate or conduction effects: Combining Bystolic with other negative chronotropes or AV node–blocking drugs (such as diltiazem, verapamil, digoxin, amiodarone, clonidine, or certain antiarrhythmics) may increase the risk of bradycardia or heart block. If clonidine is used, clinicians often taper the beta-blocker first before withdrawing clonidine to minimize rebound hypertension.
Other interactions: Nonsteroidal anti-inflammatory drugs (NSAIDs) may blunt antihypertensive effects in some patients. Concomitant use with other blood pressure medications can enhance hypotension—often intended but requiring monitoring. Beta-blockers may reduce the effectiveness of beta-agonists such as albuterol; patients with asthma or COPD should discuss their inhaler regimen. Insulin and oral hypoglycemics can have altered hypoglycemia symptom recognition with beta-blockers, necessitating closer glucose monitoring. Always provide your clinician and pharmacist a complete list of prescription drugs, over-the-counter medicines, and supplements.
Missed dose
If you miss a dose of Bystolic and remember the same day, take it as soon as you remember. If it is close to the time for your next dose, skip the missed dose and resume your normal schedule. Do not double up to make up for a missed dose. If you miss doses frequently, speak with your healthcare professional about strategies to improve adherence or whether a different regimen may be appropriate.
Overdose
Symptoms of overdose can include profound bradycardia, severe hypotension, heart block, acute heart failure, bronchospasm, and hypoglycemia. This is a medical emergency—call emergency services or go to the nearest emergency department. Treatment may involve atropine for bradycardia, intravenous fluids and vasopressors for hypotension, glucagon for beta-blocker toxicity, bronchodilators for bronchospasm, and continuous cardiac monitoring in a controlled setting.
Storage
Store Bystolic tablets at controlled room temperature (generally 68–77°F or 20–25°C), away from excessive heat, moisture, and direct light. Keep the medication in its original container with the label intact, and out of reach of children and pets. Do not use tablets past the expiration date. Ask your pharmacist about safe disposal—do not flush unless the label specifically instructs, and consider take-back programs if available.
U.S. sale and prescription policy
In the United States, Bystolic (nebivolol) is a prescription-only medication. It is not legal or safe to obtain it without a valid prescription from a licensed clinician. Websites or sellers that offer to ship Bystolic “no prescription required” should be avoided—these sources may be counterfeit, improperly stored, or unsafe, and using them can put your health at risk.
Geisinger HealthSouth provides a legal, structured pathway to access care for hypertension that may include Bystolic when clinically appropriate. This typically involves a same-day or scheduled evaluation by a licensed clinician (in-person or via telehealth), evidence-based prescribing if indicated, and electronic transmission of your prescription to a trusted pharmacy. You receive counseling on dosing, side effects, interactions, and follow-up monitoring to ensure that treatment is safe and effective.
If cost is a concern, ask about generic nebivolol, which may lower your out-of-pocket expense. Geisinger HealthSouth can also help verify insurance coverage, explore pharmacy options (including mail-order), and coordinate blood pressure monitoring or lab work. These compliant, patient-centered services protect your health and privacy—without resorting to unsafe attempts to buy Bystolic without prescription.
To get started, schedule an appointment, complete a brief medical history, and bring an updated medication list. After your evaluation, if nebivolol is appropriate, your clinician will explain the dose, how to take it, how to monitor blood pressure and heart rate at home, and when to follow up. This integrated approach ensures you receive the right medication, at the right dose, with ongoing support.
