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Is Switching From Nebivolol To Losartan Advisable?

Posted on Mon, 9 Jan 2017

Question: I take nebivolol 1.25 mg daily in the morning.
I did not try any ED drugs yet (still worried about its side effects and safety).

BP is consistently 140/80. HR is 80 most of the time (but it may reach 110 in the morning in some days).

My questions are:

(1) Can I take nebivolol only on the days in which HR is high in the morning?

(2) Knowing that Losartan may improve ED, would switching to Losartan be helpful in reducing HR when it is on its higher rate?

(3) Is it possible to have nebivolol only on the days of high HR and Losartan on the other days?

Thank you ..

Answered by Dr. Rishu Saxena (41 minutes later)

Brief Answer:
Amlodipine and ivabradine combination is perfect for you!

Detailed Answer:
Hi
Firstly thanks for choosing health care magic for your query ,

Your answer are as follows-

(1)Nebivolol is a cardioselective beta blockers used in hypertensives, as per your records your blood pressure is around 140/80.
Target blood pressure for adults (over age of 45 ) is less the 140/90 mm of hg , so for your age your blood pressure is perfectly normal, right now your main issue is erectile dysfunction with increased heart rate , i would suggest you to shift to amlodipine (calcium channel blocker) ,this is a very safe antihypertensive and a low dose will be good for you.So for your first question my answer is no nebivolol or any other antihypertensive has to be taken every day .Its not advisable to take it SOS(as and when required).
As for your heart rate , i would suggest you to take tablet ivabradine every day, it is a very safe medicine and can infact be taken on the days when you feel you have tachycardia. Its much more safer then nebivolol ,which has erectile dysfunction as a main side effect.

2) Losartan is a at 1 antagonist -a very good anti hypertensive drug but it has no or minimal effect on heart rate, so its not your cup of tea.Amlodipine is much better for you as being a calcium channel blocker it effect the blood pressure and might help you with mild tachycardia.

3)No whether it is nebivolol or losartan every doctor will taper your doses and would try to maintain you on lowest possible doses , but you can not take them SOS(as and when required).

Don't worry there are many safer substitute available in current scenario,
Just ask your cardiologist to start you on a low dose of amlodipine and ivabradine.

In case you have any further query feel free to ask!

Thanks,
Dr Rishu Saxena
Cardiologist XXXXXXX hospital XXXXXXX ,New XXXXXXX
( YYYY@YYYY )

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Rishu Saxena (5 hours later)

Thank you for the prompt and detailed answer. My follow up question is.. Would it be enough to have the Ca channel blocker only as it has a lowering effect on HR?

Answered by Dr. Rishu Saxena (8 minutes later)

Brief Answer:
Yes try it for 21 days initially if not controlled add ivabrad.

Detailed Answer:
Hi dear,
Every body is different and how your body will respond to a particular medicine can be known only when you start taking that medicine.Start with a low dose of amlodipine and monitor your bp and pulse rate every third day for 21 days , if pulse rate is still high you can add ivabradine.
Amlodipine is a dihydropyridine group of calcium channel blocker which unlike any other calcium channel blocker has minimal effect on heart rate, but in your case you have minimal tachycardia(110/min);so it can solve the dual purpose of regulating b.p and heart rate.

If there is tachycardia after 21 days of therapy also , your physician will add ivabradine to your prescription.

Thank you,
Dr Rishu Saxena
Cardiologist

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Yogesh D