ReviewsRecent advances in the treatment of renal diseases with nebivolol: A literature review
Introduction
Beta-blockers are the second line agents in treatment of hypertension excluding patients with coronary artery diseases as well as it has not been received the Food and Drug Administration (FDA) approval in patients with heart failure. Nebivolol is a novel β-blocker that has been available for a number of years for the treatment of hypertension, either taken alone or in combination with other antihypertensive agents. It is a third-generation β-blocker that exhibits highly selective β1-adrenergic receptor blockade and nitric oxide mediated vasodilation. The beneficial effects of nebivolol as an antihypertensive treatment are not associated with the usual side effects of other β-blockers. Nebivolol was also shown to interfere with amyloid-β protein precursor (AβPP) processing in neuronal like cells and exert estrogen like neuroprotective effects. Animal study by Wang et al. showed that chronic application of nebivolol is highly tolerable and safe and can significantly reduce neuropathology in the brain, which is one of the most important parameters for primary prevention of Alzheimer's disease (AD) [1].
Section snippets
Method
This paper has written in accordance with review of systematic literature search via PubMed from inception to December 2015 and Google Scholar using medical subject headings that combined with terms for acute kidney injury or chronic kidney disease. Then this method supplemented with author's working knowledge and reference lists of review article and textbooks, and with references in articles that author found relevant.
Pharmacodynamics
Generally, in pharmacology references beta-blockers are categorized as cardioselective (atenolol, bisoprolol, metoprolol, nebivolol), non-selective (nadolol, propanolol, timolol), intrinsic sympathomimetic activity (acebutolol, carteolol, penbutolol, pindolol) and mixed α- and β-blockers (carvedilol, labetalol). Currently, based on receptor affinity and hemodynamic properties, available β-blockers can be categorized into one of four principle groups: non-cardioselective and non-vasodilatory,
Clinical efficacy
The FDA's approval of nebivolol was based on its hypertensive effectiveness in the two pivotal randomized, double-blind, multicenter, placebo-controlled trials conducted in the United States (US). Both studies concluded that nebivolol was safe, well tolerated and effective for patients with mild to moderate hypertension [2]. Now clinical efficacy of nebivolol is discussed in the following states.
Adverse effects of nebivolol
Based on product insert monograph (Forest Laboratories Canada Inc. 2014) in placebo-controlled monotherapy trials, the most common adverse events (> 2% patients) observed with BYSTOLIC were headache (7.1%), fatigue (3.6%), nasopharyngitis (3.1%), dizziness (2.9%), diarrhoea (2.5%) and upper respiratory tract infections (2.1%). Other adverse drug effects (less than 1%) such as diabetes mellitus, gout, hypercholesterolemia, hyperkalemia, hyperlipidemia, depression, bradycardia, myocardial
Drug interactions
Co-administration with fluoxetine (also metabolized by CYP2D6) in extensive CYP2D6 metabolizers impeded the apparent clearance of nebivolol [50]. There was no interaction between ranitidine and nebivolol. Although cimetidine inhibited nebivolol metabolism, it did not have a significant influence on the pharmacodynamics of drug [51]. Furthermore, in interaction of nebivolol with anti-epileptic drugs, it showed anti-epileptic effect in addition to its reported antihypertensive effect. Thus the
Conclusion
Oxidative stress plays a large role in the development of resistant or difficult-control hypertension as well as contributing to end organ damage such as cardiovascular disease, stroke and chronic kidney disease. Nebivolol attenuates the endothelial dysfunction and the vascular oxidative stress. Furthermore, it lowers the L-NAME induced high LDL levels. Nebivolol can now be added to list of the third-generation beta-blockers because of antioxidant properties and free radical scavenging ability
Disclosure of interest
The author declares that she has no competing interest.
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Transcriptomics and protein biomarkers reveal the detoxifying mechanisms of UV radiation for nebivolol toward zebrafish (Danio rerio) embryos/larvae
2022, Aquatic ToxicologyCitation Excerpt :It has been listed as one of the highly prescribed pharmaceuticals in the U.S.A. (Brown, 2015). However, it cannot be completely metabolized after administration, and consequently a considerable amount of NEB is excreted into wastewater system (Amiri, 2016). Conventional biological municipal wastewater treatment plants (WWTPs) cannot effectively remove NEB, discharging a large proportion of NEB to the natural receiving waters (Salma et al., 2017).
Does nebivolol have renoprotective action in patients with chronic kidney disease conditions? An integrative review
2021, European Journal of PharmacologyCitation Excerpt :Cianci et al. (2013) also reported that NEB can be used in the treatment of patients with RAS, since it exerts a post-surgical nephroprotective action (Cianci et al., 2013). Shamekhi and Amiki (2016) concluded, from a bibliographic survey, that NEB has a nephroprotective effect in various kidney diseases (glomerulonephritis, nephrotoxicity, DN and CKD) due to the decrease in antioxidant action and endothelial dysfunction; these factors corroborate improved cardiorenal functions (Shamekhi Amiri, 2016). This review contributes to the literature by presenting an amplitude of results through the years, in addition to inclusion and interrelation criteria between animal models and research in humans.
Photochemical degradation of nebivolol in different natural organic matter solutions under simulated sunlight irradiation: Kinetics, mechanism and degradation pathway
2020, Water ResearchCitation Excerpt :Nebivolol is a third generation β-blocker and has the highest β1-blocking activity among β-blockers (Münzel et al., 2009). It was reported that the β1-receptor affinity of nebivolol is 321 times higher than that of propranolol and carvedilol (Amiri, 2016). Nebivolol has been listed as one of the top-sold prescription pharmaceuticals in the USA (Brown, 2015).
Nebivolol prevents ethanol-induced reactive oxygen species generation and lipoperoxidation in the rat kidney by regulating NADPH oxidase activation and expression
2017, European Journal of PharmacologyCitation Excerpt :Additional effects of nebivolol include NO production via activation of β3-adrenergic receptors, inhibition of NADPH oxidase and direct O2− scavenging (Oelze et al., 2006; Maffei and Lembo, 2009; Serg et al., 2012). Reactive oxygen species play an important role in both acute and chronic kidney diseases and due to its antioxidant actions nebivolol has been shown to be effective in the treatment of various states of renal diseases (Shamekhi Amiri, 2016). Additionally, nebivolol elicits renal vasodilation and increases renal blood flow and glomerular filtration rate (Greven and Gabriëls, 2000).
Ameliorative effect of nebivolol in doxorubicin-induced cardiotoxicity
2023, Journal of Medicine and LifeRenal pharmacotherapy: Dosage adjustment of medications eliminated by the kidneys
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