Introduction About NEBICARD V TABLET

NEBICARD V TABLET is a combination of Nebivolol and Valsartan, which belong to the group of medicines called Beta-blockers and Angiotensin-II receptor blockers respectively. NEBICARD V TABLET is used to manage essential hypertension (high blood pressure) in adults. Hypertension is a common and long-term condition in which the force of the blood is consistently high against the walls of the arteries, which can increase the risk of heart disease, kidney disease, and stroke.

Before taking NEBICARD V TABLET, inform your doctor if you are pregnant or breastfeeding. Inform your doctor if you have any problems related to the kidney, liver, lungs, or heart or if you have other conditions such as diabetes, psoriasis, hyperthyroidism, or dehydration problems.

If you are taking any other medicines for other conditions or if you have a history of drug allergies, inform your doctor as it may manage drug-related interactions and serious side effects. The most common side effects of NEBICARD V TABLET are headache, dizziness, tiredness, nausea, and diarrhoea. Consult your doctor for advice if your symptoms get worse over time.

Uses Of NEBICARD V TABLET

• Manage essential hypertension (high blood pressure)

How NEBICARD V TABLET Works

NEBICARD V TABLET helps to reduce high blood pressure, whereas nebivolol works by reducing the force of contraction of the heart muscles by blocking the effects of certain hormones called adrenaline and making the heart beat more easily, thus lowering the blood pressure, and valsartan works by relaxing the blood vessels by blocking a substance called angiotensin-II (which causes blood vessels to tighten) that is produced in the body and thus lowering the blood pressure.

How to use NEBICARD V TABLET

Always take NEBICARD V TABLET as directed by your physician. Take NEBICARD V TABLET with or without food. Swallow NEBICARD V TABLET as a whole and do not crush or chew the medicine. Do not stop taking NEBICARD V TABLET unless advised by your doctor.

Side Effects Of NEBICARD V TABLET

How To Manage Side Effects

Diarrhoea:

Drink plenty of fluids, such as water, fruit juices, or electrolytes (ORS), to avoid dehydration in your body. Consult your doctor if your symptom does not improve.

Constipation:

Consume fiber-rich foods such as fresh fruits and vegetables and whole grain cereals, as well as plenty of fluids. Exercise more regularly and stay active. Consult your doctor if your symptoms worsen.

Tiredness:

Drink plenty of fluids and eat a balanced diet with frequent meals. Maintain a regular sleep schedule and engage in regular, minimal exercise. Consult your doctor if your symptoms worsen.

Dizziness:

Lie down until the dizziness passes away, and then move slowly and carefully. Take plenty of rest and drink plenty of fluids. Consult your doctor if your symptoms worsen.

Headache:

Apply a hot or cold-water bag to your head. Try taking a rest in a quiet and dark room. Drink tea or coffee. Consult your doctor if your symptoms worsen.

Warning & Precautions

Pregnancy

NEBICARD V TABLET is not recommended for use in early pregnancy, and it should not be taken if you are pregnant for more than 3 months as it may cause serious harm to the baby. Consult with your doctor for advice before taking NEBICARD V TABLET.

Breastfeeding

NEBICARD V TABLET is not recommended for use by breastfeeding women. Consult your doctor for advice before taking NEBICARD V TABLET.

Driving and Using Machines

Do not drive or operate any machines if you experience dizziness or fatigue. Consult your doctor for advice before taking NEBICARD V TABLET.

Alcohol

Consumption of alcohol is not recommended during management with NEBICARD V TABLET.

Kidney

NEBICARD V TABLET should be used with caution in patients with severe kidney impairment or disease, renal artery stenosis (narrowing of blood vessels leading to the kidneys), and in patients undergoing dialysis or with a surgical history of a kidney transplant. Consult your doctor for advice before taking NEBICARD V TABLET.

Liver

NEBICARD V TABLET is not recommended for use in patients with severe liver impairment, biliary cirrhosis (damage of bile ducts in the liver), or cholestasis (bile flow from the liver is reduced or stopped). It should be used with caution in patients with mild or moderate liver impairment. Consult your doctor for advice before taking NEBICARD V TABLET.

Allergy

Do not take NEBICARD V TABLET if you are allergic to Nebivolol and Valsartan.

Lungs

NEBICARD V TABLET is not recommended for use in patients with a history of asthma or wheezing and should be used with caution in patients with prolonged breathing problems or chronic obstructive pulmonary disease. Consult your doctor for advice before taking NEBICARD V TABLET.

Heart Disease

NEBICARD V TABLET is not recommended for use in patients with heart failure, heart rhythm and conduction disorders, slow heart rate, low blood pressure, or poor circulatory problems in the arms or legs. It should be used with caution in patients with chest pain and first-degree heart block. Consult your doctor for advice before taking NEBICARD V TABLET.

Interactions

A. Drug-Drug interactions:

Before taking NEBICARD V TABLET inform your doctor, if you are taking any of these medicines:

• hydroquinidine, disopyramide, amiodarone, methyldopa, digoxin, diltiazem, clonidine, guanfacine, mexiletine, nifedipine, nimodipine (used to manage heart rhythm problems or high blood pressure)
• phenobarbital, secobarbital (used to manage seizures) 
• thioridazine (used to manage schizophrenia)
• phenothiazine drugs such as chlorpromazine, and prochlorperazine (used to manage nausea and vomiting)
• amitriptyline, paroxetine, fluoxetine (used to manage depression)
• salbutamol, theophylline (used to manage asthma)
• oxymetazoline, naphazoline (used to manage blocked nose)
• travoprost, bimatoprost (used to manage glaucoma)
• baclofen (used to manage muscle spasms)
• amifostine (used as a protective agent during cancer management)
• cimetidine (used to manage excess stomach acid or ulcers) 
• potassium supplements or potassium-sparing diuretics such as spironolactone, and amiloride (used to retain or increase potassium levels)
• angiotensin-converting enzyme (ACE) inhibitor drugs such as enalapril, ramipril or aliskiren (used to manage high blood pressure)
• heparin (used as a blood thinning agent)
• non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (used to manage pain and swelling)
• lithium (used to manage depression)
• ciclosporin (used to manage organ rejection after transplant)
• ritonavir (used to manage HIV/AIDS)
• rifamycin groups such as rifapentine, and rifaximin (used to manage bacterial infections)
• insulin and oral antidiabetic drugs such as metformin, and glibenclamide (used to manage diabetes)

Overdosage:

If you or anyone else accidentally take too much of NEBICARD V TABLET, consult your doctor immediately. Overdosage may cause undesirable effects such as low blood pressure with possibly fainting, severe dizziness, slow heartbeat, breathlessness, and acute heart failure.

Synopsis

More Information

• Keep NEBICARD V TABLET out of reach from children
• Store at room temperature 

FAQs About NEBICARD V TABLET

What should I do if I forget to take NEBICARD V TABLET?

You should take NEBICARD V TABLET immediately when you remember. If it is time for your next dose, skip the dose and follow your regular dose schedule. Do not double the dose to make up for your missed dose.

Can NEBICARD V TABLET be taken together with painkillers?

NEBICARD V TABLET when taken together with painkillers such as ibuprofen, diclofenac, or high doses of aspirin may reduce the effect of NEBICARD V TABLET in lowering blood pressure. Both of these medicines, when taken together, may affect kidney function more severely, especially if you are elderly or have pre-existing kidney disease.

Can NEBICARD V TABLET be used in hyperthyroid patients?

Yes, NEBICARD V TABLET should be used with caution in patients with hyperthyroidism as it can hide the symptoms of hyperthyroidism, such as a fast heartbeat. If you stop taking NEBICARD V TABLET suddenly, it will increase the risk of developing serious hyperthyroidism symptoms. Do not stop taking the medicine on your own without consulting your doctor.

Does NEBICARD V TABLET impair the ability to drive?

Yes, NEBICARD V TABLET may cause dizziness or tiredness; do not drive or operate any machines that require concentration because it can impair your ability to drive or work. You may ask someone to drive for you or follow appropriate precautions before driving after consulting with your doctor.

For how long should I take NEBICARD V TABLET?

You should continue taking NEBICARD V TABLET unless your doctor tells you to stop taking the medicine. Blood pressure medicines will usually be taken for a lifetime to manage complications due to high blood pressure. Your doctor may change management with another hypertension drug if you do not attain any therapeutic effect with NEBICARD V TABLET.

References

1. KD Tripathi. Antiadrenergic drugs (Adrenergic Receptor Antagonists) and drugs for glaucoma & Drugs affecting the renin-angiotensin system and plasma kinins. Essentials of medical pharmacology. Seventh edition. 2013. Page – 149 & 563; 507.

2. Forest Laboratories. Study of the Efficacy and Safety of the Combination of Two FDA Approved Oral Medications, Nebivolol and Valsartan for Treatment of Stage 1 or 2 Hypertension. NIH U.S. National Library of Medicine ClinicalTrials.gov. April 2014. [Accessed 13th April 2022] https://clinicaltrials.gov/ct2/show/NCT01508026

3. Thomas D. Giles, John R. Cockcroft, Bertram Pitt, Abhijeet Jakate, and Harold M. Wright. Rationale for nebivolol/valsartan combination for hypertension: a review of preclinical and clinical data. NIH National Library of Medicine, National center for biotechnology information. PMC. May 2015. [Accessed 13th April 2022] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548499/

4. Balkanpharma Dupnitsa AD. Health Products Regulatory Authority (HPRA). [Revised on May 2021] [Accessed 13th April 2022] http://www.hpra.ie/img/uploaded/swedocuments/80c0a2ec-3e9a-4b23-915c-984871eb9d11.pdf

5. APL Swift Services (Malta) Limited. Electronic Medicines Compendium (EMC). [Revised in September 2021] [Accessed 13th April 2022] https://www.medicines.org.uk/emc/files/pil.7120.pdf

6. Mylan Laboratories, Inc. U.S. Food & Drug Administration. [Revised in June 2011] [Accessed 13th April 2022] https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021742s013lbl.pdf

7. Torrent pharmaceuticals Ltd. NEBICARD-V Tablet (Nebivolol Hydrochloride and Valsartan). Torrent Pharma. [Revised on December 2021] [Accessed 13th April 2022] https://www.torrentian.com/pisheet/Upload/PI_Sheet/1199.pdf                                                                             

Useful Diagnostic Tests

• Kidney Function Test