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Indications & Uses
Carnovas is indicated for:
Pharmacology
Nebivolol is a β adrenergic receptor blocking agent. It inhibits both β1 and β1 adrenergic receptors. At therapeutically relevant concentrations, nebivolol lacks intrinsic sympathomimetic and membrane stabilizing activity. At clinically relevant doses, it does not demonstrate β1-adrenergic receptor blockade activity. Various metabolites, including glucuronides, contribute to the beta-blocking activity.
The mode of action of nebivolol involves decreased heart rate, decreased myocardia contractility, diminution of tonic sympathetic outflow to the periphery from cerebral vasomotor centers, suppression of renin activity, and vasodilation and decreased peripheral vascular resistance.
Pharmacokinetics
Nebivolol is metabolized by a number of routes, including glucuronidation and hydroxylation by CYP2D6. The active isomer (d-nebivolol) has an effective half-life of about 12 hours in CYP2D6 extensive metabolizers (most people), and 19 hours in poor metabolizers. Exposure to d-nebivolol is substantially increased in poor metabolizers. This matters less than usual, however, because the metabolites, including the hydroxyl metabolite and glucuronides (the predominant circulating metabolites), contribute to the b blocking activity.
Absorption and Distribution
Absorption of nebivolol is similar to an oral solution. Mean peak plasma nebivolol concentrations occur approximately 1.5 to 4 hours post-dosing in EMs and PMs. Food does not alter the pharmacokinetics of nebivolol, so it may be given without regard to meals. The in vitro human plasma protein binding of nebivolol is approximately 98%, mostly to albumin, and it is independent of nebivolol concentrations.
Metabolism and Excretion
Nebivolol is mainly metabolized by direct glucuronidation of the parent drug, and to a lesser extent by N-dealkylation and oxidation via cytochrome P450 2D6. After a single oral dose of 14C-nebivolol, 38% of the dose was recovered in urine and 44% in feces for EMs. For PMs, 67% was recovered in urine and 13% in feces.
Digoxin
Nebivolol (10 mg once daily) and digoxin (0.25 mg once daily) were given together for 10 days to 14 healthy adults. There were no significant changes in the pharmacokinetics of digoxin or nebivolol.
Warfarin
Nebivolol (10 mg once daily for 10 days) led to no significant changes in the pharmacokinetics of nebivolol or R- or S-warfarin after a single 10 mg dose of warfarin. In the same way, nebivolol has no significant effect on the anticoagulant activity of warfarin, as assessed by Prothrombin time and INR profiles from 0 to 144 hours after a single 10 mg warfarin dose in 12 healthy adult volunteers.
The starting dose should be reduced in patients with moderate hepatic impairment. No formal studies have been done in patients with severe hepatic impairment, and nebivolol should be contraindicated for these patients.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Nebivolol doses are set to suit each patient. For most people the usual starting dose is 5 mg once daily, and it can be taken with or without food. It can be used on its own as monotherapy or together with other agents.
If blood pressure needs to come down further, the dose can be raised at intervals of 2 weeks, up to 40 mg. Giving the medicine more often than once daily is unlikely to bring any extra benefit.
Side Effects
Side-effect information is not available for this brand yet.
Cautions & Contraindications
Warnings & Precautions
Abrupt Cessation of Therapy Patients with coronary artery disease who are treated with Nebivolol Hydrochloride should be told not to stop it suddenly. After β-blockers were stopped abruptly, severe worsening of angina has been reported in patients with coronary artery disease, along with myocardial infarction and ventricular arrhythmias. Myocardial infarction and ventricular arrhythmias may happen with or without the angina pectoris getting worse first. Even patients with no obvious coronary artery disease should be warned against interrupting or abruptly stopping the medicine. As with other β-blockers, when stopping Nebivolol Hydrochloride is planned, patients should be watched carefully and advised to keep physical activity to a minimum. Where possible, the dose should be tapered over 1 to 2 weeks. If the angina gets worse or acute coronary insufficiency develops, it is recommended that Nebivolol Hydrochloride be restarted promptly, at least for a while. Cardiac Failure In congestive heart failure, sympathetic stimulation is an important support for circulation, and β-blockade may depress the contractility of the heart muscle further and bring on more severe failure. Nebivolol Hydrochloride should be given with care to patients whose congestive heart failure is compensated. If the heart failure gets worse, stopping Nebivolol Hydrochloride should be considered. Angina and Acute Myocardial Infarction Nebivolol Hydrochloride was not studied in patients with angina pectoris or in those who had a recent MI. Bronchospastic Diseases In general, patients with bronchospastic diseases should not receive 3-blockers. Anesthesia and Major Surgery If Nebivolol Hydrochloride is continued during surgery, patients should be monitored closely when anesthetic agents that depress heart function, such as ether, cyclopropane and trichloroethylene, are used. If β-blocking therapy is withdrawn before major surgery, the heart's weakened ability to respond to reflex adrenergic stimuli may add to the risks of general anesthesia and surgical procedures. The β-blocking effects of Nebivolol Hydrochloride can be reversed by β-agonists, for example dobutamine or isoproterenol. But these patients may then suffer prolonged severe hypotension. Difficulty in restarting and maintaining the heartbeat has also been reported with β-blockers. Diabetes and Hypoglycemia β-blockers may hide some signs of hypoglycemia, particularly tachycardia. Nonselective β-blockers may increase insulin-induced hypoglycemia and delay the recovery of serum glucose levels. It is not known whether nebivolol has these effects. Patients who are prone to spontaneous hypoglycemia, and diabetic patients taking insulin or oral hypoglycemic agents, should be told about these possibilities, and nebivolol should be used with caution. Thyrotoxicosis β-blockers may hide clinical signs of hyperthyroidism, such as tachycardia. If β-blockers are withdrawn abruptly, the symptoms of hyperthyroidism may get worse or a thyroid storm may be triggered. Peripheral Vascular Disease In patients with peripheral vascular disease, β-blockers can bring on or worsen symptoms of arterial insufficiency. Caution should be taken with these patients. Non-dihydropyridine Calcium Channel Blockers β-blockers combined with calcium channel blockers of the verapamil and diltiazem type have significant negative inotropic and chronotropic effects. So caution should be used in patients taking these medicines together with Nebivolol Hydrochloride, and ECG and blood pressure should be monitored.
Contraindications
Nebivolol must not be given to patients with severe bradycardia, heart block greater than first degree, cardiogenic shock, decompensated cardiac failure, or severe hepatic impairment (Child-Pugh >B). It is also contraindicated in sick sinus syndrome, unless a permanent pacemaker is in place. And anyone who is hypersensitive to any component of this product should not take it.
Use in Special Populations
Impaired Renal Function
Use Nebivolol Hydrochloride with caution in patients with severe renal impairment, because the kidneys clear the medicine more slowly in these patients. It has not been studied in patients receiving dialysis.
Impaired Hepatic Function
Use Nebivolol Hydrochloride with caution in patients with moderate hepatic impairment, because the medicine is metabolised more slowly. It has not been studied in patients with severe hepatic impairment, so it is contraindicated in this group.
Risk of Anaphylactic Reactions
Patients who take β-blockers and have a history of severe anaphylactic reactions to many different allergens may react more strongly to repeated challenges, whether accidental, diagnostic or therapeutic. These patients may also not respond to the usual doses of epinephrine given to treat allergic reactions.
Storage
Store Nebivolol Hydrochloride below 30°C, and keep it away from light and moisture. Keep it out of the reach of children.
Drug Interactions
Common questions about Carnovas 10 mg
What is Carnovas 10 mg Tablet?
Carnovas 10 mg Tablet is a medicine that contains Nebivolol Hydrochloride. It is made by Beximco Pharmaceuticals Ltd. It belongs to the Beta-adrenoceptor blocking drugs group of medicines.
What is Carnovas used for?
Carnovas is used for: Hypertension, Heart Failure.
How should I store Carnovas?
Store Nebivolol Hydrochloride below 30°C, and keep it away from light and moisture. Keep it out of the reach of children.
Can I take other medicines with Carnovas?
Some medicines can interact with Nebivolol Hydrochloride, for example: Disopyramide, Paroxetine, Fluoxetine, Clonidine Hydrochloride, Verapamil Hydrochloride, Diltiazem Hydrochloride. Tell your doctor or pharmacist about every medicine you take.
Is there a cheaper medicine with the same ingredient?
Carnovas is already among the lowest-priced brands of Nebivolol Hydrochloride at this strength.
Do I need a prescription for Carnovas?
Carnovas is a prescription (Rx) medicine. Take it as your doctor advises.