This combination is indicated in essential hypertension.

Nebivolol and Hydrochlorothiazide combination produces an additive antihypertensive effect, resulting in a greater reduction in blood pressure than either drug alone. Nebivolol has mild vasodilatory properties, which help lower heart rate and blood pressure in hypertensive patients. Hydrochlorothiazide acts on the renal tubular mechanisms of electrolyte reabsorption, increasing the excretion of sodium and chloride in approximately equal amounts. Its diuretic effect reduces plasma volume and subsequently increases plasma renin activity and aldosterone secretion.

Once daily, preferably at the same time every day. Use in children is not recommended.

Nebivolol:

• Class I and Class III antiarrhythmics, calcium channel blockers (Verapamil, Diltiazem),
• centrally acting antihypertensives, anaesthetics,
• antipsychotics, antidepressants, NSAIDs may interact.

Hydrochlorothiazide:

• Drugs affecting potassium and calcium levels,
• NSAIDs may interact.
• Concomitant use of this combination with antipsychotics, tricyclic antidepressants, and barbiturates may enhance the hypotensive effect and lead to postural hypotension.

• Hypersensitivity to the active substances, hepatic impairment.
• Severe renal insufficiency (Creatinine clearance < 30 ml/min), bradycardia, hypotension.

Nebivolol: Headache, dizziness, fatigue, diarrhoea, constipation, nausea etc.
Hydrochlorothiazide: Vertigo, itching, rash, increased skin sensitivity to sunlight etc.

This combination is not recommended during pregnancy or breastfeeding.

Nebivolol: Beta-blockers should not be used in untreated congestive heart failure (CHF) and bradycardia. Use with caution in patients with chronic obstructive pulmonary disease (COPD), as airway constriction may worsen.

Hydrochlorothiazide: In renal disease, thiazides may increase azotaemia. If renal impairment progresses, therapy should be reassessed. It may cause fluid and electrolyte imbalance. It can reduce urinary calcium excretion and slightly increase serum calcium in the absence of calcium metabolism disorders.

No specific data available. Hydrochlorothiazide overdose may cause electrolyte depletion and dehydration due to excessive diuresis.

Combined antihypertensive preparations

Protect from light and moisture. Store below 30°C. Keep out of reach of children.