Nebivolol

-6.01/-5.01 mmHg

A 2025 review of 91 randomized trials reported these average systolic and diastolic differences versus placebo. The systolic comparison with active drugs was not statistically significant; diastolic lowering favored nebivolol by 0.71 mmHg. The outcome was office blood pressure.¹¹⁶⁵

Older heart failure outcomes

In SENIORS, 2,128 people aged 70 or older had all-cause death or cardiovascular admission rates of 31.1% with nebivolol and 35.3% with placebo over a mean 21 months. Mortality alone was 15.8% versus 18.1% and remained inconclusive.¹¹⁶⁶

Exercise capacity in HFpEF

ELANDD included 116 people with symptomatic heart failure and ejection fraction above 45%. Six months of nebivolol did not improve walking distance or peak oxygen uptake over placebo.¹¹⁶⁷

Mechanism and comparisons

12 people

A crossover study compared nebivolol with atenolol while both groups received the same diuretic. Its endpoints were forearm responses to acetylcholine and L-NMMA. Clinical outcomes were outside this 12-person physiological design.¹¹⁶⁸

Endothelial function

A review of ten studies found no clear flow-mediated-dilation advantage over other beta blockers. The pooled endpoint gives little evidence of a consistent advantage despite the nitric-oxide findings in individual experiments.^1169,1168

Erectile outcomes by comparator

Four randomized comparisons involving 397 people favored nebivolol over metoprolol by 1.81 points on IIEF-5, but heterogeneity was 99%. The placebo comparison in a separate network review was too imprecise to establish a benefit.^1170,1171

Regional studies and drug handling

Chinese hypertension trial

A Chinese abstract reports 315 people randomized to nebivolol or bisoprolol for 12 weeks, with response rates of 73.4% and 69.7% (P>0.05). Only the abstract was available, leaving formal equivalence and rare harms unresolved.¹¹⁷³

Russian hormone comparison

A 40-man comparison reported small erectile-score and testosterone changes over 12 weeks. Its abstract calls the study blinded while its methods call it open, and multiple design and reporting problems make the hormone result highly uncertain.¹¹⁷⁴

Japanese volunteer study

Six healthy men received nebivolol and two received placebo for seven days. The report addressed circulation and drug handling, leaving nitric-oxide involvement unresolved.¹¹⁷⁵

Labels, recalls and retractions

US and UK indications

The US label covers hypertension. The UK label also covers stable mild or moderate chronic heart failure alongside standard treatment in people aged 70 or older.^1176,1177

Valsartan combination

An eight-week trial in 4,161 adults found more blood-pressure lowering with nebivolol plus valsartan than with either component. FDA withdrew Byvalson approval effective May 23, 2024, after the manufacturer said it was no longer marketed and requested withdrawal. The notice gives no nebivolol safety finding.^1179,1180

Tablet test

A 2024 paper tested three 2.5 mg tablet lots for nine named nitrosamines and found none. N-nitroso nebivolol, the NDSRI named in the Aurobindo recall, was not among the analytes. Three authors were affiliated with the company that supplied the tablets and facilities.^1183,1181

Retractions

A rat kidney paper was retracted after concerns about shared data, specimen images and unavailable raw data. A tissue-regeneration paper was retracted over altered images and inadequate raw material. Both reports are excluded from the clinical evidence.^{1184,1185,1186,1187}

Reported adverse reactions

A rhabdomyolysis report involved a 75-year-old woman also taking high-dose fluvastatin, leaving a possible interaction. Another patient developed reversible hyperkalemia. In a third report, a 73-year-old woman developed liver-enzyme elevations three months after nebivolol was added; levels returned close to baseline within four weeks of withdrawal.^{1188,1189,1190}

Common questions

01 How much does nebivolol lower blood pressure?

A 2025 review of 91 randomized trials found average office blood-pressure reductions of 6.01 mmHg systolic and 5.01 mmHg diastolic beyond placebo. The review included 7,737 people who received nebivolol, across different regimens and study populations.¹¹⁶⁵

02 Does it lower blood pressure more than other medicines?

Average systolic reductions did not differ significantly from the active drugs in the 2025 review. The average diastolic difference favored nebivolol by 0.71 mmHg. The comparison depends on the other medicine and the trial population.¹¹⁶⁵

03 What did the SENIORS trial actually show?

Among 2,128 people aged 70 or older with heart failure, death or a cardiovascular hospital admission occurred in 31.1% with nebivolol and 35.3% with placebo. Average follow-up was 21 months. The combined endpoint improved; mortality alone was inconclusive.¹¹⁶⁶

04 Does it improve exercise capacity in HFpEF?

The ELANDD trial found no improvement over placebo in walking distance or peak oxygen uptake after six months. It included 116 people with symptomatic heart failure and an ejection fraction above 45%.¹¹⁶⁷

05 Is nebivolol better for erections than metoprolol?

A 2025 review of four randomized trials favored nebivolol by 1.81 points on the IIEF-5 questionnaire. The trials included 397 people, and their results varied sharply. That makes the average useful for comparison but uncertain for an individual.¹¹⁷⁰

06 Does it improve erections compared with placebo?

That comparison is uncertain. A network review found a benefit over nonvasodilating beta blockers, while its placebo comparison was too imprecise to establish an effect.¹¹⁷¹

07 Why do reviews describe erectile-function results differently?

A questionnaire score and the number of people with ED are distinct outcomes. A Korean review found a score advantage but an inconclusive difference in new ED. In a separate 119-man bypass-surgery paper, the significant result belonged to the score comparison; the abstract attached it to the ED percentages.^{1191,1170,1192}

08 Did the bypass-surgery study prove sexual protection?

It offers limited evidence. Sixty men were randomized, but the paper tested changes within each group and did not report a direct comparison of those changes. Their starting scores differed, and heart surgery itself could affect the outcome.¹¹⁹³

09 What happened when men switched from another beta blocker?

In a study of 44 men, 29 had erectile dysfunction before switching to nebivolol. Twenty of those 29 improved over three months. There was no control group, so stopping the previous drug and other changes could explain some of the improvement.¹¹⁹⁴

10 Does nebivolol improve insulin sensitivity?

In one randomized comparison, insulin sensitivity stayed about the same with nebivolol and worsened with metoprolol. Forty-six people with metabolic syndrome completed the study. The difference supports a more neutral metabolic effect in that setting.¹¹⁷²

11 Does nebivolol raise testosterone?

A small Russian study reported a change from 11.38 to 11.74 nmol/L in the nebivolol group over 12 weeks. It enrolled 40 men and reported its blinding inconsistently. That leaves the hormone finding too uncertain to support testosterone treatment.¹¹⁷⁴

12 Is its effect on blood-vessel function unique?

A review of ten studies found no clear advantage over other beta blockers in the pooled flow-mediated dilation result. Individual experiments support nitric-oxide effects; whether that mechanism produces a larger clinical benefit remains unresolved.^1169,1168

13 What did the 12-person nitric-oxide study measure?

It measured forearm blood-vessel responses during treatment with nebivolol or atenolol, each combined with the same diuretic. Acetylcholine tested stimulated dilation; L-NMMA tested a separate constrictor response. It had no heart-attack, admission or survival endpoint.¹¹⁶⁸

14 What evidence is there for combining it with valsartan?

An eight-week randomized trial assigned 4,161 adults with hypertension to the combination, either drug alone or placebo. The combination lowered blood pressure more than its components. FDA withdrew approval of the US combination product Byvalson on May 23, 2024, after its manufacturer said it was no longer marketed and requested withdrawal.^1179,1180

15 What do we know from longer treatment?

One nebivolol-valsartan study followed treatment for a year. Of 810 participants, 489 completed it, and 59.2% reported an adverse event. Because everyone received treatment and many did not finish, the study gives a limited picture of long-term safety.¹¹⁹⁵

16 Has severe muscle injury been reported?

Yes. A Korean report described rhabdomyolysis in a 75-year-old woman after a switch to nebivolol. She also took fluvastatin, and the authors discussed a possible drug interaction. She recovered after a medication change and hospital care; the report cannot tell us how often this occurs.¹¹⁸⁸

17 Can nebivolol affect potassium?

A case report described high potassium in a 47-year-old woman, with normalization after nebivolol was reduced and stopped. It is a possible adverse effect recorded in one patient. Its frequency and risk factors are unclear.¹¹⁸⁹

18 Have skin reactions been reported?

Published cases describe lichenoid eruptions and skin darkening that improved after nebivolol was stopped. These reports identify possible reactions; they provide no reliable estimate of how common they are.^1196,1197

19 Has breast enlargement been reported in men?

One report described a 42-year-old man whose breast enlargement regressed after nebivolol was stopped. The authors investigated other causes. A single case leaves the frequency uncertain.¹¹⁹⁸

20 Is the kidney-protection research reliable?

One 2020 rat paper was retracted in July 2026 after concerns about shared data, specimen images and unavailable raw data. We exclude it from supporting evidence. Other kidney studies need their own assessment.^1184,1185

21 What does the Japanese volunteer study add?

It adds a small early study of drug handling and circulation: six healthy men received nebivolol and two received placebo for seven days. Nitric-oxide involvement was unresolved in that experiment.¹¹⁷⁵

22 Do all beta-blocker results apply to nebivolol?

A major Cochrane review of first-line hypertension outcomes contained no eligible trial of newer vasodilating beta blockers such as nebivolol. Most beta-blocker recipients in that review took atenolol.¹¹⁹⁹

23 What is nebivolol?

Nebivolol is a prescription beta blocker used to lower blood pressure. Tablets contain nebivolol hydrochloride, a salt form of the drug. It is a small molecule rather than a peptide.^1176,1200

24 What is it approved for?

The US label covers hypertension. The UK label also covers stable mild or moderate chronic heart failure alongside standard treatment in people aged 70 or older.^1176,1177

25 Are nebivolol and nebivolol hydrochloride different medicines?

The hydrochloride is the salt supplied in the labeled tablets. US tablet strengths are expressed as the equivalent amount of nebivolol base. The label and identity records distinguish the salt weight from the active-drug amount.^{1176,1201,1200}

26 Why does CYP2D6 matter?

CYP2D6 helps metabolize nebivolol. People who metabolize it slowly have higher exposure to the active d-nebivolol form, and medicines that inhibit CYP2D6 can also raise exposure. Active metabolites contribute to the overall effect.¹¹⁷⁶

27 How long does nebivolol stay in the body?

The US label gives an effective half-life of about 12 hours for d-nebivolol in extensive metabolizers and 19 hours in poor metabolizers. Other figures may describe a different isomer, metabolite or population, so a single number can be misleading.^1176,1177

28 Can antidepressants change its effects?

Some can. The label describes increased exposure with fluoxetine. In a separate study of 23 healthy adults, paroxetine increased parent-nebivolol exposure 6.1-fold. The interaction depends on the exact antidepressant and the rest of the medication list.^1176,1178

29 Can it be combined with sildenafil or tadalafil?

Sildenafil has been studied with nebivolol; tadalafil-specific interaction data are unverified in the cited sources. The sildenafil study found roughly additive effects on pulse and blood pressure, making low blood pressure a practical concern.¹¹⁷⁶

30 Can I stop it suddenly?

Stopping suddenly can worsen angina and has been associated with heart attacks and abnormal rhythms in beta-blocker users. The label calls for a planned withdrawal under clinical supervision.¹¹⁷⁶

31 Can it slow the heart too much?

Yes. Severe bradycardia and several conduction disorders are listed contraindications. In the older heart-failure population described by the UK label, bradycardia was reported in about 11% with nebivolol and 2% with placebo.^1176,1177

32 Is it safe with asthma or other breathing problems?

Breathing problems need a medication review. In a single-dose study of 12 people with mild asthma, nebivolol reduced the maximum measured FEV1 by about 0.27 liters on average. The US label says people with bronchospastic disease generally should not receive beta blockers.^1202,1176

33 Does it hide low blood sugar?

It can mask a fast heartbeat, an early warning sign of hypoglycemia. The label also warns of severe or prolonged low blood sugar, particularly with diabetes, fasting, vomiting or in children.¹¹⁷⁶

34 What is known about use during pregnancy?

Human nebivolol data are insufficient to define developmental risk. Beta-blocker exposure late in pregnancy can affect a newborn’s heart rate, blood pressure, glucose and breathing. Hypertension itself also carries pregnancy risks, so medication decisions need individual review.^1176,1203

35 What about breastfeeding?

Human milk levels and effects on breastfed infants are unknown. The US label does not recommend nebivolol during nursing because beta blockers can cause serious reactions in infants, especially a slow heart rate.^1176,1204

36 Is nebivolol banned in sport?

WADA’s 2026 list names nebivolol under P1 for archery, automobile, billiards, darts, golf, mini-golf, shooting and specified underwater sports. The restriction also applies outside competition in the marked archery, shooting and underwater disciplines. The published 2027 list retains it.^1205,1206

37 Do food, alcohol or supplements change nebivolol exposure?

Food does not materially change nebivolol absorption. The UK label reports that alcohol did not change its pharmacokinetics. Specific grapefruit, iodine and other supplement interactions are unverified in the cited sources.^1176,1177

38 Did the insulin-sensitivity trial report side effects?

The journal article gives little detail, but its registry does. Over 18 weeks, including the washout and placebo periods, other adverse events were reported in 14 of 23 nebivolol participants and 7 of 23 metoprolol participants; neither group reported a serious event. Those counts describe reported events without assigning causation to every event.^1207,1172

39 What happened to the tissue-regeneration paper?

The publisher retracted the 2021 nebivolol chitosome paper after finding inappropriate changes to images in Figure 6. The authors agreed to the retraction. We exclude its wound-healing claims from the evidence.^1186,1187

40 Does adding nebivolol always improve blood pressure?

Results depend on the setting. In a 491-person trial adding nebivolol to lisinopril or losartan, the main systolic blood-pressure outcome was not statistically significant. The secondary diastolic outcome improved. That mixed result belongs alongside the positive monotherapy trials.¹²⁰⁸

41 Can my resting pulse predict how well it will lower blood pressure?

A Korean observational analysis found that the change in pulse after treatment was associated with the blood-pressure response. Baseline pulse was less informative. The study groups were defined after treatment, so the result offers limited help in predicting an individual response beforehand.^1209,1210

42 What if I have poor circulation in my legs?

A Cochrane review included two nebivolol comparisons in people with peripheral arterial disease. They found no significant differences in walking symptoms, ankle-brachial index or mortality versus the comparators. The limited results apply to the circulation problems and treatment plans that were studied.¹²¹¹

43 Does it protect the kidneys?

Human kidney studies have mixed results. In one 120-person study around coronary angiography, kidney-injury rates did not differ significantly among nebivolol, N-acetylcysteine and hydration-only groups. Other small studies measure filtration, protein excretion or blood flow; long-term prevention of kidney failure remains unestablished.^{1212,1213,1214,1215}

44 Can it prevent heart damage during chemotherapy?

Routine prevention is uncertain. In the 80-person CONTROL trial, nebivolol did not significantly preserve pumping function on MRI after 12 months. A 2026 review reported fewer study-defined cardiotoxicity events, but the pooled outcome included silent ultrasound changes from a trial with untreated controls.^{1216,1217,1218}

45 Have any nebivolol products been recalled?

Yes. FDA records include an N-nitroso nebivolol impurity recall for specific Aurobindo 2.5 mg lots and a cross-contamination recall for a specific AvKARE 20 mg lot. Both were still marked ongoing in the September 23, 2026 database update. A pharmacist can check the manufacturer, strength and lot on a particular supply.^1181,1182

46 Does it interact with sulfonylurea diabetes medicines?

The UK label warns that beta blockers can increase the risk of severe hypoglycemia when combined with sulfonylureas. It advises careful glucose monitoring. Nebivolol can also mask a fast heartbeat that would otherwise warn of low blood sugar.¹¹⁷⁷

47 What did the Chinese hypertension trial find?

The 315-person trial reported response rates of 73.4% with nebivolol and 69.7% with bisoprolol over 12 weeks, P>0.05. The abstract lacks the detail needed to establish formal equivalence or compare rare harms.¹¹⁷³

48 Does nebivolol improve cholesterol or blood sugar?

Results vary by measure. In a registered 26-week diabetes trial, average HbA1c changed by +0.12 percentage points with nebivolol and 0.00 with metoprolol; no comparison test was posted. Smaller lipid studies also give mixed results, including an unfavorable LDL subfraction change in one uncontrolled study.^{1219,1220,1221}

49 What about blood pressure near the heart?

A 98-person randomized study measured central systolic pressure over 12 weeks. It fell by 17.2 mmHg with nebivolol and 29.3 mmHg with telmisartan. Telmisartan produced the larger reduction in that open-label comparison.¹²²²

50 Does it reduce plaque in the arteries?

A small study found no clear plaque benefit over atenolol. It randomized 29 people and analyzed 24 after one year; the main plaque-type measure and the between-group plaque-area change were not significant. Other vessel changes differed, with baseline blood-flow patterns complicating interpretation.¹²²³

51 Does nebivolol make a steroid or clenbuterol cycle safer?

The clinical evidence behind this chapter has not tested that use. Whether nebivolol reduces heart damage from anabolic steroids or clenbuterol is unknown; no protective dose or drug ratio is established in the sources behind this chapter.¹¹⁷⁷

52 What side effects show up in trials?

The US hypertension trials reported headache, fatigue, dizziness, nausea and diarrhea. Some dose groups also reported slow heart rate, insomnia, shortness of breath, swelling and rash more often than placebo. The UK label includes constipation.^1176,1177

53 What strengths are available, and can the tablet be split?

US tablets contain the equivalent of 2.5, 5, 10 or 20 mg of nebivolol base. The UK label uses 5 mg daily for hypertension and a different, supervised titration for older people with stable heart failure. Splitting instructions need to be checked for the exact product.^1176,1177

54 Can it be taken with another blood-pressure medicine?

Yes, combinations have been studied, including valsartan and add-on treatment with lisinopril or losartan. The effect and risks depend on the partner drug. Amlodipine-type medicines can add to low blood pressure; verapamil and diltiazem can worsen heart conduction.^{1176,1177,1179,1208}

55 Is it approved for anxiety or a fast heart rate?

Those are not listed indications in the US or UK labels. The US label covers hypertension; the UK label also covers stable mild or moderate chronic heart failure in people aged 70 or older.^1176,1177

56 Can nebivolol cause insomnia or sleepiness?

Both appear in the US label. Insomnia was reported in 1% of each nebivolol dose group and 0% with placebo in the hypertension trials. Sleepiness was reported after marketing; its frequency is unknown.¹¹⁷⁶

57 Have sexual effects been studied in women?

A registered crossover study enrolled 29 women, but only 15 had paired sexual-function results. Mean questionnaire changes were similar, with no comparison test posted. The record says collected adverse-event data were destroyed and unavailable.¹²²⁴

58 Can nebivolol affect the liver?

A 2024 report described liver-enzyme elevations in a 73-year-old woman three months after nebivolol was added. Levels returned close to baseline within four weeks of stopping it. The authors judged the link probable; how often this happens is unknown.¹¹⁹⁰