Uses and Administration
Nebivolol is used in the management of hypertension in Kenya. It is given by mouth and the usual dose is 5 mg of nebivolol daily. An initial dose of 2.5 mg daily is used in the elderly and in patients with renal impairment. Hydrochlorothiazide reduces the amount of fluid in the blood vessels, by increasing their elimination through the urinary system.
Common Adverse Effects of Nebivolol
Nebivolol is generally well tolerated and most adverse effects are mild. The most frequent and serious adverse effects reported in Kenya are related to Nebivolol’s beta-adrenergic blocking activity. Among the most serious adverse effects are heart failure, heart block, and bronchospasm. Troublesome subjective side-effects include fatigue and coldness of the extremities. Reactions may be more severe following intravenous than oral administration; ocular use has also been associated with systemic adverse effects. When beta blockers are used for long-term treatment of asymptomatic diseases such as hypertension, subjective side-effects may be an important determinant of patient compliance.
Adverse Effects of Hydrochlorothiazide
Hydrochlorothiazide and other thiazide diuretics may cause a number of metabolic disturbances especially at high doses. They may provoke hyperglycaemia and glycosuria in diabetic and other susceptible patients. They may cause hyperuricaemia and precipitate attacks of gout in some patients. Administration of thiazide diuretics may be associated with electrolyte imbalances including hypochloraemic alkalosis, hyponatraemia, and hypokalaemia. Hypokalaemia intensifies the effect of digitalis on cardiac muscle and administration of digitalis or its glycosides may have to be temporarily suspended. Patients with cirrhosis of the liver in Kenya are particularly at risk from hypokalaemia. Hyponatraemia may occur in patients with severe heart failure who are very oedematous, particularly with large doses in conjunction with restricted salt in the diet. The urinary excretion of calcium is reduced. Hypomagnesaemia has also occurred. Adverse changes in plasma lipids have also been noted but their clinical significance is unclear.
Signs of electrolyte imbalance include dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pain and cramps, seizures, oliguria, hypotension, and gastrointestinal disturbances.
Other side-effects include anorexia, gastric irritation, nausea, vomiting, constipation, diarrhoea, sialadenitis, headache, dizziness, photosensitivity reactions, orthostatic hypotension, paraesthesia, impotence, and yellow vision. Hypersensitivity reactions include skin rashes, fever, pulmonary oedema, pneumonitis, anaphylaxis, and toxic epidermal necrolysis. Cholestatic jaundice, pancreatitis, and blood dyscrasias including thrombocytopenia and, more rarely, granulocytopenia, leucopenia, and aplastic and haemolytic anaemia have been reported.
Intestinal ulceration has occurred after the use of tablets containing thiazides with an enteric-coated core of potassium chloride