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NEW DRUG DEVELOPMENTS

Nebivolol: A Third-Generation ß-Adrenergic Blocker

Assistant Professor of Pharmacy, School of Pharmacy, Wingate University, Wingate, NC

Donald S Nuzum, PharmD

Assistant Professor of Pharmacy, School of Pharmacy, Wingate University

Jamie L Jolly, PharmD CDE

at time of writing, Assistant Professor of Pharmacy, School of Pharmacy, Wingate University; now, Medical Liaison, Daiichi Sankyo Inc., Parsippany, NJ

Reprints: Dr. Veverka, School of Pharmacy, Wingate University, 316 N. Main St., Wingate, NC 28174-0157, fax 704/233-8332, aveverka{at}wingate.edu

OBJECTIVE: To describe the pharmacologic and pharmacokinetic properties of a new ß-adrenergic blocker, nebivolol, and review the literature evaluating its efficacy in the treatment of hypertension and heart failure.

DATA SOURCES: Articles were identified through searches of MEDLINE (1996-May 2006) and International Pharmaceutical Abstracts (1970-May 2006), using the key word nebivolol. Additional references were selected from the bibliographies of the articles cited. Searches were not limited by language, time, or human subject.

STUDY SELECTION AND DATA EXTRACTION: Preclinical studies evaluating the pharmacologic and pharmacokinetic properties of nebivolol in humans were selected for review. Randomized, controlled, blinded clinical trials assessing the efficacy of nebivolol for the treatment of hypertension and heart failure were also included.

DATA SYNTHESIS: Preclinical data have established nebivolol as a third-generation ß-adrenergic blocker, as it possesses vasodilatory properties that contribute to its hemodynamic effects beyond those achieved at ß-adrenergic receptors. Short-term, randomized, controlled clinical trials have shown nebivolol to be as effective as other antihypertensive therapies at lowering blood pressure. One long-term trial showed a significant reduction in death and hospital admissions for cardiovascular causes when nebivolol was compared with placebo in patients with heart failure (31.1% vs 65.3%; HR 0.86; 95% CI 0.74 to 0.99).

CONCLUSIONS: Nebivolol is a novel ß-adrenergic blocker that possesses unique pharmacologic properties, compared with other agents in its class. Nebivolol appears to be as effective as other antihypertensive agents at lowering blood pressure and possesses benefits for patients with heart failure. Additional studies are needed to address the long-term benefits of nebivolol for hypertension, to compare nebivolol with other ß-adrenergic blockers for heart failure, and to investigate the clinical relevance of nitric oxide-mediated vasodilation.

Key Words: ß-adrenergic blockers, heart failure, hypertension, nebivolol, nitric oxide

Published Online, July 5, 2006. www.theannals.com, DOI 10.1345/aph.1G708

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