A fixed-dose combination (FDC) of a third-generation, highly selective beta-1 adrenergic blocker (Nebivolol) and an angiotensin II receptor blocker (ARB) (Telmisartan). This combination provides synergistic blood pressure control through complementary mechanisms: Nebivolol reduces heart rate and cardiac output while promoting nitric oxide-mediated vasodilation, and Telmisartan blocks the renin-angiotensin-aldosterone system (RAAS) causing vasodilation and reduced aldosterone secretion. It is indicated for the management of essential hypertension in patients whose blood pressure is not adequately controlled on monotherapy.
Adult: One tablet (Nebivolol 5mg + Telmisartan 40mg) once daily, preferably at the same time each day. Dose titration should be based on individual response. Initiation with a lower dose of Nebivolol (e.g., 2.5mg) may be considered in some patients.
Note: Can be taken with or without food. Swallow whole with a glass of water. Do not crush or chew. Regular monitoring of blood pressure, heart rate, renal function, and electrolytes (especially potassium) is recommended.
The combination exerts a dual antihypertensive action. Nebivolol is a highly selective beta-1 adrenergic receptor antagonist. At therapeutic doses, it competitively blocks catecholamine binding at cardiac beta-1 receptors, reducing heart rate, myocardial contractility, and cardiac output. Uniquely, it also stimulates endothelial nitric oxide (NO) synthase (eNOS), leading to NO-mediated vasodilation and reduced peripheral vascular resistance. Telmisartan is a selective, competitive antagonist at the angiotensin II type 1 (AT1) receptor. It blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II, leading to vasodilation, decreased aldosterone release (reducing sodium and water retention), and reduced sympathetic outflow.
Pregnancy: CONTRANDICATED in 2nd and 3rd trimesters (Telmisartan: FDA Category D). Drug exposure during these trimesters can cause injury and death to the developing fetus (oligohydramnios, renal failure, skull hypoplasia, contractures). Discontinue as soon as pregnancy is detected. Use in 1st trimester only if clearly needed.
Driving: May cause dizziness, fatigue, or blurred vision, especially at initiation of therapy. Patients should not drive or operate machinery until they know how the medication affects them.
| Other Antihypertensives (Diuretics, CCBs, ACEIs) | Additive hypotensive effect; risk of severe hypotension. | Major |
| Digoxin | Nebivolol may increase digoxin concentration; risk of bradycardia. | Moderate |
| Antiarrhythmics (Amiodarone, Disopyramide) | Increased risk of bradycardia and myocardial depression. | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May reduce antihypertensive effect of Telmisartan; increase risk of renal impairment and hyperkalemia. | Major |
| Potassium-sparing diuretics (Spironolactone), Potassium supplements | Increased risk of hyperkalemia with Telmisartan. | Major |
| Lithium | Telmisartan may increase lithium levels and toxicity. | Major |
| CYP2D6 Inhibitors (Fluoxetine, Paroxetine, Quinidine) | May increase Nebivolol plasma levels. | Moderate |
| Insulin, Oral Hypoglycemics | Nebivolol may mask tachycardia as a sign of hypoglycemia. | Moderate |
| Clonidine | Risk of rebound hypertension if clonidine is withdrawn while on beta-blocker. | Major |
Same composition (Nebivolol (5mg) + Telmisartan (40mg)), different brands: