Nevalto

Indications

Neobloc-V (Nebivolol/Valsartan) is a combination medication used to treat hypertension by effectively lowering blood pressure. This dual-action drug helps reduce the risk of severe cardiovascular events, such as strokes and heart attacks, by combining a beta-blocker with an angiotensin II receptor blocker (ARB).

Pharmacology

Nebivolol, a selective beta-blocker, helps manage heart rate and strengthens heart contractions while dilating blood vessels to lower blood pressure. Valsartan, an ARB, blocks the action of angiotensin II on the AT1 receptor, which further dilates blood vessels and reduces blood pressure without altering heart rate.

Dosage & Administration

For initial therapy or patients inadequately controlled on 80 mg of Valsartan or up to 10 mg of Nebivolol, the recommended dose of Neobloc-V is one 5 mg/80 mg tablet daily. Optimal antihypertensive effects are usually observed within 2 to 4 weeks. Increasing the dosage beyond 5 mg/80 mg does not significantly improve blood pressure control. This combination may replace individual components for patients already using 5 mg Nebivolol and 80 mg Valsartan.

Always follow your doctor’s instructions regarding medication.

Interactions

• CYP2D6 Inhibitors: May increase Nebivolol levels.
• Reserpine or Clonidine: May cause excessive reduction in sympathetic activity.
• Digitalis Glycosides: Increase risk of bradycardia.
• Calcium Channel Blockers (e.g., Verapamil, Diltiazem): May cause severe reductions in heart rate, blood pressure, and cardiac contractility.
• Potassium-Sparing Diuretics and Supplements: May raise serum potassium levels.
• NSAIDs: May reduce antihypertensive efficacy and increase renal impairment risk.
• Dual Renin-Angiotensin System Inhibition: Increased risk of renal impairment, hypotension, and hyperkalemia.

Contraindications

Neobloc-V is contraindicated in:

• Severe bradycardia
• Heart block greater than first degree
• Cardiogenic shock
• Decompensated cardiac failure
• Sick sinus syndrome (unless a permanent pacemaker is in place)
• Severe hepatic impairment (Child-Pugh >B)
• Hypersensitivity to any component
• Co-administration with aliskiren in diabetic patients

Side Effects

Common side effects include:

• Hypotension
• Hyperkalemia

Pregnancy & Lactation

Neobloc-V may harm the fetus and is not recommended during pregnancy. Avoid breastfeeding while using this medication.

Precautions & Warnings

• Discontinuation: Do not abruptly stop therapy to avoid acute coronary artery disease exacerbation.
• Diabetes: Monitor glucose levels as beta-blockers may mask hypoglycemia symptoms.
• Renal Function: Regularly check renal function and potassium levels in susceptible patients.

Use in Special Populations

• Pediatric Use: Safety and efficacy in children have not been established.
• Geriatric Use: No significant differences in safety or efficacy between elderly and younger patients.
• Renal Impairment: Not recommended as initial therapy in severe renal impairment; starting dose should be 2.5 mg daily.
• Hepatic Impairment: Limited data available for use in hepatic insufficiency.

Overdose Effects

• Nebivolol: Supportive care is essential. Treat bradycardia with IV atropine, hypotension with IV fluids and vasopressors, and severe heart block with isoproterenol or pacing if necessary. Address bronchospasm and hypoglycemia with appropriate treatments.
• Valsartan: Overdose may lead to hypotension and tachycardia. Bradycardia might occur due to parasympathetic stimulation. Valsartan is not removed by hemodialysis.

Therapeutic Class

Combined antihypertensive preparations.

Storage Conditions

Store Neobloc-V at room temperature, below 30°C, in a dry place away from light. Keep out of reach of children.