PRESCRIPTION NOTICE: Nebilong H is a Prescription Only Medicine (POM). It cannot legally be dispensed without a valid prescription from a licensed healthcare provider in Kenya. Do not use this medicine without medical supervision. Do not share this medicine with others even if they appear to have the same condition.
Nebilong H Tablets are a prescription-only fixed-dose combination antihypertensive medicine containing two complementary active ingredients — nebivolol (a highly selective third-generation beta-1 adrenergic blocker) and hydrochlorothiazide (a thiazide diuretic). Each pack contains 30 film-coated tablets, providing a one-month supply at standard once-daily dosing.
The combination of a beta-blocker and a thiazide diuretic in a single tablet represents a well-established and guideline-recommended antihypertensive strategy, targeting blood pressure through two distinct and synergistic physiological mechanisms simultaneously. This dual-action approach often achieves superior blood pressure reduction compared to either agent used alone, while the fixed-dose combination format simplifies the treatment regimen and supports long-term adherence. If you have been prescribed Nebilong H for hypertension treatment in Kenya, this medicine must be taken strictly as directed by your healthcare provider alongside appropriate lifestyle modifications. The price of Nebilong H in Kenya varies by pharmacy and is dispensed only on presentation of a valid prescription.
Key Benefits
- Dual-action antihypertensive — combines two complementary mechanisms in a single once-daily tablet for superior blood pressure control
- Nebivolol’s unique vasodilatory effect — unlike older beta-blockers, nebivolol stimulates endothelial nitric oxide release, actively dilating blood vessels and further lowering peripheral vascular resistance
- Highly cardioselective beta-1 blockade — nebivolol has one of the highest beta-1 selectivity profiles among beta-blockers, minimising respiratory and metabolic side effects
- Hydrochlorothiazide reduces blood volume — by promoting sodium and water excretion through the kidneys, complementing the cardiac effects of nebivolol
- Fixed-dose combination format — reduces pill burden, simplifies dosing, and improves long-term treatment adherence
- Once-daily dosing — supports consistent blood pressure control throughout the 24-hour period
- Metabolically favourable compared to older beta-blocker and diuretic combinations — nebivolol’s nitric oxide-mediated vasodilation partially offsets the metabolic disadvantages associated with thiazide diuretics
- Suitable for a broad range of hypertensive patients including those with concurrent heart failure or coronary artery disease under specialist guidance
What It Is & How It Works
Active Ingredients
Each film-coated tablet contains:
| Active Ingredient | Strength | Role |
|---|---|---|
| Nebivolol Hydrochloride | 5 mg | Third-generation cardioselective beta-1 blocker with nitric oxide-mediated vasodilatory properties |
| Hydrochlorothiazide | 12.5 mg | Thiazide diuretic — reduces blood volume by promoting renal sodium and water excretion |
How Each Ingredient Works
Nebivolol — Third-Generation Beta-Blocker
Nebivolol exerts its antihypertensive effect through two synergistic mechanisms that distinguish it from earlier generation beta-blockers:
- Selective beta-1 adrenergic receptor blockade — nebivolol binds with exceptionally high selectivity to beta-1 adrenergic receptors on cardiac muscle cells. This blockade reduces heart rate (negative chronotropy), reduces the force of myocardial contraction (negative inotropy), and suppresses renin release from the juxtaglomerular apparatus of the kidney — collectively lowering cardiac output and blood pressure
- Nitric oxide (NO)-mediated vasodilation — uniquely among beta-blockers, nebivolol stimulates endothelial L-arginine/nitric oxide synthase (eNOS) pathways, increasing the production and bioavailability of nitric oxide in the vascular endothelium. Nitric oxide causes direct relaxation of vascular smooth muscle, leading to peripheral vasodilation, reduced systemic vascular resistance, and further blood pressure lowering. This vasodilatory mechanism also improves endothelial function and has favourable effects on arterial compliance
Hydrochlorothiazide — Thiazide Diuretic
Hydrochlorothiazide lowers blood pressure primarily through its diuretic action:
- Inhibition of sodium-chloride cotransporter (NCC) in the distal convoluted tubule of the kidney — this prevents sodium and chloride reabsorption, increasing urinary sodium excretion and secondary water loss, reducing intravascular blood volume and consequently lowering blood pressure
- Reduction of peripheral vascular resistance — with chronic use, hydrochlorothiazide produces direct vascular smooth muscle relaxation independent of its diuretic effect, contributing to sustained antihypertensive efficacy beyond the initial volume reduction
Synergistic Combination Effect
The combination of nebivolol and hydrochlorothiazide produces additive and complementary blood pressure lowering. Hydrochlorothiazide’s volume-reducing effect can trigger compensatory activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system — effects that are directly counteracted by nebivolol’s beta-blockade and renin suppression. This mutual counterbalancing of compensatory mechanisms results in more sustained and complete blood pressure control than either agent achieves independently.
Classification
Nebilong H is classified as a Prescription Only Medicine (POM) in Kenya. It must only be initiated, monitored, and adjusted by a licensed healthcare provider. A valid prescription is required for dispensing at any registered pharmacy in Kenya.
Formulation
Film-coated tablets. Each pack contains 30 tablets. Tablets should be swallowed whole with water, with or without food, preferably at the same time each day.
Uses & Indications
Nebilong H Tablets are indicated for:
- Essential hypertension (primary high blood pressure) — in adults whose blood pressure is not adequately controlled on a single antihypertensive agent alone
- As a fixed-dose combination step-up therapy — in patients already stabilised on the individual components (nebivolol and hydrochlorothiazide) at the same doses contained in the combination tablet
- Hypertension with concurrent conditions — including patients with stable coronary artery disease, mild to moderate chronic heart failure, or metabolic syndrome, under appropriate specialist guidance
IMPORTANT: Nebilong H is indicated for the management of hypertension in adults. It is not indicated as initial first-line therapy in newly diagnosed, uncomplicated hypertension — monotherapy with a single antihypertensive agent is typically initiated first. The decision to initiate, adjust, or discontinue Nebilong H therapy must be made exclusively by a licensed healthcare provider based on individual clinical assessment and regular blood pressure monitoring. Do not self-prescribe or alter your dose without consulting your doctor.
Dosage & Administration
This medicine requires a valid prescription. Use only as prescribed by your healthcare provider. The following dosage information is provided for general reference only and does not constitute prescribing advice.
| Patient Group | Dose | Frequency |
|---|---|---|
| Adults with hypertension | As directed by physician | As directed by physician |
| Elderly patients (65+ years) | As directed by physician | As directed by physician |
| Renal impairment (mild to moderate) | As directed by physician | As directed by physician |
| Severe renal impairment (eGFR below 30 mL/min) | As directed by physician | As directed by physician |
| Hepatic impairment | As directed by physician | As directed by physician |
| Paediatric patients | As directed by physician | As directed by physician |
Administration Instructions
- Take this medicine exactly as prescribed — do not increase, decrease, or skip doses without medical advice
- Take once daily, preferably at the same time each day — morning dosing is recommended to align the diuretic effect with waking hours and avoid nocturnal diuresis
- May be taken with or without food
- Swallow tablets whole with a full glass of water — do not crush, chew, or split
- Do not stop taking this medicine suddenly without consulting your doctor — abrupt discontinuation of the beta-blocker component (nebivolol) can precipitate rebound hypertension, angina, or acute cardiac events in susceptible patients; gradual dose tapering over 1–2 weeks is required
- If a dose is missed, take it as soon as you remember on the same day — if the next day has begun, skip the missed dose and continue as normal; do not double dose
- Attend all scheduled follow-up appointments for blood pressure monitoring, renal function, and electrolyte checks — particularly serum potassium and sodium
Possible Side Effects
Like all medicines, Nebilong H may cause side effects in some patients. Report any new or worsening symptoms to your healthcare provider promptly.
Common
- Fatigue or tiredness — particularly in the first few weeks; usually improves with continued use
- Headache
- Dizziness or light-headedness — particularly upon standing (orthostatic hypotension); rise slowly from sitting or lying positions
- Cold extremities — hands and feet may feel cold due to nebivolol’s reduction of peripheral circulation
- Increased urinary frequency — expected pharmacological effect of hydrochlorothiazide; most pronounced in the first few days of treatment
- Nausea or mild gastrointestinal discomfort
Less Common
- Bradycardia (slow heart rate) — heart rate below 50–60 beats per minute; report to your doctor promptly
- Hypokalaemia (low blood potassium) — caused by hydrochlorothiazide; symptoms include muscle weakness, cramps, fatigue, and palpitations; regular potassium monitoring is essential
- Hyponatraemia (low blood sodium) — particularly in elderly patients; symptoms include confusion, headache, and generalised weakness
- Sleep disturbances or vivid dreams
- Erectile dysfunction in male patients
- Mild bronchospasm — despite nebivolol’s high cardioselectivity, some degree of bronchospasm may occur in sensitive individuals
- Hyperuricaemia (raised uric acid) — hydrochlorothiazide may precipitate gout in susceptible patients
- Hyperglycaemia — thiazide diuretics may impair glucose tolerance; monitor blood sugar in diabetic patients
WARNING: Rare but serious — seek immediate medical attention if you experience: severe bradycardia or AV heart block, acute decompensated heart failure (sudden breathlessness, ankle swelling, or rapid weight gain), severe electrolyte disturbances (muscle paralysis, severe confusion, or cardiac arrhythmias), acute angle-closure glaucoma (sudden severe eye pain, blurred vision, or visual halos — a rare but recognised adverse reaction to hydrochlorothiazide), severe allergic reactions (rash, swelling of the face or throat, difficulty breathing), or signs of serious skin reactions including Stevens-Johnson Syndrome.
This is not a complete list of side effects. Report all side effects to your healthcare provider.
Warnings & Precautions
CONTRAINDICATION: Do NOT use Nebilong H if you have acute decompensated heart failure, cardiogenic shock, second- or third-degree AV block without a pacemaker, sick sinus syndrome, severe bradycardia (heart rate below 60 bpm at rest before starting treatment), severe hypotension, severe bronchial asthma or severe COPD, severe hepatic impairment, severe renal impairment (eGFR below 30 mL/min/1.73 m²), refractory hypokalaemia or hyponatraemia, hypercalcaemia, symptomatic hyperuricaemia or gout, known hypersensitivity to nebivolol, hydrochlorothiazide, sulphonamide derivatives, or any excipient in this formulation.
Do Not Use If You:
- Have severe or acute decompensated heart failure or cardiogenic shock
- Have significant bradycardia or advanced heart block without a functioning pacemaker
- Have severe asthma or severe COPD — even cardioselective beta-blockers carry risk
- Have severe renal impairment — hydrochlorothiazide is ineffective and potentially harmful at eGFR below 30 mL/min
- Have severe liver disease — nebivolol is extensively hepatically metabolised
- Have hypersensitivity to sulphonamide-derived medicines — hydrochlorothiazide is a sulphonamide derivative; cross-reactivity is possible
- Are pregnant — hydrochlorothiazide may reduce placental perfusion; nebivolol may cause neonatal bradycardia, hypoglycaemia, and respiratory depression; use only if clearly indicated and under specialist supervision
- Are breastfeeding — both nebivolol and hydrochlorothiazide pass into breast milk; consult a doctor before use
Use With Caution If You Have:
- Mild to moderate asthma or COPD — use only under specialist supervision with close respiratory monitoring
- Diabetes mellitus — nebivolol may mask hypoglycaemia symptoms (particularly tachycardia); hydrochlorothiazide may impair glucose tolerance; monitor blood glucose carefully
- Gout or hyperuricaemia — hydrochlorothiazide raises uric acid levels; consult your doctor
- Peripheral artery disease or Raynaud’s phenomenon — nebivolol may worsen symptoms of poor circulation
- Phaeochromocytoma — only use after adequate alpha-blocker therapy has been established
- Systemic lupus erythematosus — hydrochlorothiazide may trigger or worsen SLE
- Electrolyte imbalances — correct hypokalaemia, hyponatraemia, or hypomagnesaemia before or during treatment
- Elderly patients — increased susceptibility to orthostatic hypotension, electrolyte disturbances, and falls
Do Not Combine With (Selected Key Interactions — Consult Pharmacist for Full Review):
- Calcium channel blockers of the verapamil or diltiazem type — risk of severe bradycardia, AV block, and cardiac failure; potentially life-threatening
- Other antiarrhythmics (amiodarone, flecainide, digoxin) — additive risk of bradycardia and AV conduction disturbances
- Other antihypertensive agents — additive hypotensive effects; monitor blood pressure closely
- Lithium — hydrochlorothiazide reduces renal lithium excretion, increasing lithium toxicity risk; avoid combination or monitor lithium levels closely
- NSAIDs (ibuprofen, diclofenac, aspirin) — may reduce the antihypertensive effect of both components and worsen renal function
- Potassium-depleting medicines (corticosteroids, laxatives, amphotericin B) — additive hypokalaemia risk with hydrochlorothiazide
- Potassium-sparing diuretics or potassium supplements — monitor serum potassium closely to avoid hyperkalaemia or hypokalaemia
- Antidiabetic agents (insulin, oral hypoglycaemics) — nebivolol may mask hypoglycaemia; hydrochlorothiazide may raise blood glucose; monitor carefully
- Clonidine — do not discontinue nebivolol before clonidine when stopping both; risk of rebound hypertension
- Alcohol — enhances the hypotensive effect; advise patients to limit alcohol intake
- Cholestyramine and colestipol resins — reduce the absorption of hydrochlorothiazide; take Nebilong H at least 1 hour before or 4 hours after these agents
CLINICAL NOTE (Kenya-specific): Hypertension remains one of the leading causes of cardiovascular morbidity and mortality in Kenya, with a prevalence estimated at 24–30% among adults and rising sharply in both urban and rural populations. Fixed-dose combination antihypertensive therapy — such as Nebilong H — is strongly recommended in Kenya’s Clinical Guidelines for patients not achieving blood pressure targets on monotherapy, as it reduces pill burden and significantly improves adherence in resource-limited settings. Clinicians should note that hydrochlorothiazide-induced hypokalaemia is a particularly important monitoring parameter in Kenyan patients, as dietary potassium intake may be suboptimal in some populations and concurrent use of other potassium-depleting medicines is common. Regular serum electrolyte monitoring — at least every 3–6 months — is essential. Additionally, the gout-precipitating potential of hydrochlorothiazide is clinically relevant in Kenya given the increasing prevalence of hyperuricaemia and gout associated with dietary and lifestyle changes in urban populations. Patients should be counselled on the signs of gout and advised to report joint pain or swelling promptly.
Keep out of reach of children. Store all medicines safely and securely.
Storage Instructions
- Store below 25°C in a cool, dry place
- Protect from direct sunlight, moisture, and excessive heat
- Keep tablets in their original blister packaging
- Store out of reach and sight of children
- Do not use after the expiry date printed on the packaging
- Do not transfer tablets to another container
- Dispose of unused or expired tablets safely at your local registered pharmacy — do not flush down the toilet or discard in household waste
Mandatory Disclaimer
This medicine requires a valid prescription. Do not use without medical advice. Nebilong H (Nebivolol + Hydrochlorothiazide) is a Prescription Only Medicine (POM) that must be initiated, monitored, and adjusted exclusively by a licensed healthcare provider. Do not self-prescribe, purchase without a valid prescription, or share this medicine with others. Abrupt discontinuation of this medicine — particularly the nebivolol component — without medical guidance is dangerous and may result in serious cardiac events. Regular medical follow-up including blood pressure monitoring, renal function testing, and serum electrolyte checks is a non-negotiable and essential component of safe Nebilong H therapy. This product information is provided for general educational reference only and does not constitute medical advice or replace the guidance of a qualified healthcare professional.
References
- Kenya Essential Medicines List (KEML) & Kenya Clinical Guidelines — Cardiovascular Disease: Hypertension Management and Combination Antihypertensive Therapy
- European Society of Hypertension (ESH) & European Society of Cardiology (ESC) — Guidelines for the Management of Arterial Hypertension: Combination Therapy Evidence and Beta-Blocker Review
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