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When considering the use of this medication, it is important to be aware of certain safety warnings and precautions. Please review the following information carefully and discuss any concerns with your healthcare provider.

• Do Not Discontinue Abruptly: It is crucial not to stop taking this medication suddenly without medical advice, especially if you have heart disease. Abrupt discontinuation can lead to serious complications such as chest pain, heart attack, irregular heartbeat, high blood pressure, and poor circulation. If discontinuation is necessary, your doctor will guide you to gradually reduce the dosage over 1 to 2 weeks. During this period, limit physical activity to minimize heart strain. Seek immediate medical attention if you experience chest pain, pressure, or tightness, pain spreading to your jaw, neck, or arm, unusual sweating, trouble breathing, or a fast or irregular heartbeat.

• Breathing Difficulties: This medication, a type of beta-blocker, is generally not recommended for individuals with bronchospastic conditions such as asthma, due to the risk of breathing difficulties. While it primarily targets the heart, caution is advised if you have conditions like COPD or asthma. Always consult your healthcare professional before use.

• Masked Symptoms of Low Blood Sugar: The medication may obscure typical symptoms of low blood sugar, such as a fast heartbeat or tremors, particularly if you are on blood sugar-lowering treatments like insulin or glipizide. Sweating might remain as an unaffected indicator. Discuss blood sugar monitoring strategies with your healthcare provider if you are prescribed this medication and have diabetes.

• Masked Symptoms of Hyperthyroidism: This medication can conceal signs of excess thyroid hormone, such as a rapid heartbeat. Consult your healthcare provider before stopping the medication, as abrupt withdrawal may exacerbate thyroid issues.

• Surgical Considerations: If you are scheduled for major surgery requiring anesthesia, inform your surgeon that you are taking this medication, as both it and anesthetics can reduce heart rate. This allows for appropriate monitoring during the procedure.

• Severe Allergic Reactions: Beta-blockers may decrease the effectiveness of standard treatments for severe allergic reactions and can intensify the reaction itself. Discuss any allergies with your healthcare provider and establish an action plan in case of an allergic event while on this medication.

Contraindications: This medication should not be used if you have certain conditions, including:

• Extremely slow heart rate.
• Specific heart problems (e.g., certain types of heart block, heart failure, cardiac shock, sick sinus syndrome without a pacemaker).
• Severe liver issues.

Always consult your healthcare provider before starting or discontinuing this medication to ensure it is safe for your specific health conditions.

When taking this medication, you may experience some mild and common side effects such as headaches, dizziness, lightheadedness, tiredness, nausea, and trouble sleeping. These effects are generally manageable, but if they persist or worsen, it's important to consult your healthcare provider. To help with dizziness and lightheadedness, try to rise slowly from sitting or lying positions.

In some instances, the medication may cause diarrhea, stomach pain, or a tingling sensation. It can also reduce blood flow to your hands and feet, making them feel cold, with smoking potentially worsening this effect. Dressing warmly and avoiding tobacco can help mitigate these symptoms. If any of these side effects become bothersome, reach out to your healthcare provider for advice.

On rare occasions, more serious side effects can occur. These include blue fingers or toes, fainting, a very slow heartbeat, new or worsening symptoms of heart failure such as shortness of breath, swelling of the ankles or feet, unusual tiredness, or sudden weight gain. Mental or mood changes like confusion, mood swings, or depression are also possible. If you experience any of these, seek medical attention promptly.

Severe allergic reactions, while very rare, require immediate medical assistance. Symptoms include rash, itching, swelling of the face, tongue, or throat, severe dizziness, and trouble breathing. Additionally, chest pain, swelling in the arms or legs, and shortness of breath should be addressed by a healthcare professional without delay. If you notice any other unexpected effects, contact your doctor or pharmacist for guidance.

Certain medications and products can interact with nebivolol (Bystolic), potentially altering its effects. It's important to inform your doctor and pharmacist about all medications and supplements you are taking, including over-the-counter drugs and herbal products.

Significant Drug Interactions:

1. Fingolimod and Other Medications:

   • Fingolimod is one of the drugs that can interact with nebivolol. If these medications are prescribed together, your doctor might adjust the dosages or how often you take them.
   • Other medications that can interact include Albuterol, Bupropion, Ceritinib, Cinacalcet, Clonidine, Crizotinib, Diltiazem, Doxepin, Dronedarone, Duloxetine, Fenoldopam, Fluoxetine, Formoterol, and many others.

2. Increased Side Effects:

   • Combining nebivolol with certain drugs may increase the risk of side effects. However, this combination might be necessary for the best treatment outcome. Your doctor may need to adjust doses or administration frequency.
   • These medications include Acarbose, Aceclofenac, Acemetacin, Acetyldigoxin, Albiglutide, Alfuzosin, Alogliptin, Amtolmetin Guacil, and many more, including common NSAIDs like Ibuprofen and Naproxen.

Always discuss medication changes with your healthcare provider to ensure safe and effective treatment.