Expert: Domenic Sica - 6/9/2009

Question
QUESTION: I am 53 years hypertensive male on Atenolol 100 Lisinorpil and Amlodepine 5 mg. Yesterday my dr changed atenolol 100 to nebivolol 5 mg stating that atenolol is no longer recommended and the drug of nebivolol is of 3rd generation. I have occassional ventricular ectopia and sever concentric LVH and dystolic dysfunction. I need your guidance whether nebivolol is superiro in terms of eeficacy I take atenolol 100 since so many years. If a suggested change is must then dose of 5 mg of nebivolol ok because i take atenolol 100 I am ex asthamatic

ANSWER: Has your blood pressure been well-controlled on the regimen prior to the switch to nebivolol ? If so, it is unclear as to why the nebivolol would be stated to be superior unless you were having side-effects with the atenolol. Also, on a dose comparison basis 5-mg of nebivolol is much less than 100-mg of atenolol. As to the issue of side-effects sometimes one does not know if they were feeling poorly on a medication until they come off it and go on a substitute medication; thus, a trial of nebivolol might be useful since it is generally better tolerated than is the case for atenolol.

Good luck,

Domenic Sica, M.D.

---------- FOLLOW-UP ----------

QUESTION: My BP is well controlled with atenolol 100.My dr remarked when I went to see him that now a days atenolol is no longer recommended and that he changed it to nebivolol 5 mg In fact I continue with atenolol 100 As you are providing good information I thought it prudrnt to seek your guidance whether to start nebivolol and if yes nebivolol 5 mg is enough and that what is the dose equivalence of atenolol 100 to nebivolol ?

Answer
The dose equivalence would be 10 to 15-mg of nebivolol for 100-mg of atenolol. You might try the nebivolol for one month and see what your blood pressure does and how you feel.  If you notice no difference in how you feel then the cheaper alternative atenolol is probably going to be the long-term treatment of choice.

Regards,

Domenic Sica, M.D.