What happens if I overdose Od-Neb?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include severe dizziness; shortness of breath; swelling of the hands, ankles, or feet; trouble breathing; very slow heart rate; wheezing.
Proper storage of Od-Neb:
Store Od-Neb at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Od-Neb out of the reach of children and away from pets.
Overdose of Od-Neb in details
In clinical trials and worldwide postmarketing experience there were reports of Od-Neb overdose. The most common signs and symptoms associated with Od-Neb overdosage are bradycardia and hypotension. Other important adverse reactions reported with Od-Neb overdose include cardiac failure, dizziness, hypoglycemia, fatigue and vomiting. Other adverse reactions associated with ß-blocker overdose include bronchospasm and heart block.
The largest known ingestion of Od-Neb worldwide involved a patient who ingested up to 500 mg of Od-Neb along with several 100 mg tablets of acetylsalicylic acid in a suicide attempt. The patient experienced hyperhydrosis, pallor, depressed level of consciousness, hypokinesia, hypotension, sinus bradycardia, hypoglycemia, hypokalemia, respiratory failure and vomiting. The patient recovered.
Because of extensive drug binding to plasma proteins, hemodialysis is not expected to enhance Od-Neb clearance.
If overdose occurs, provide general supportive and specific symptomatic treatment. Based on expected pharmacologic actions and recommendations for other ß-blockers, consider the following general measures, including stopping Od-Neb, when clinically warranted:
Bradycardia: Administer IV atropine. If the response is inadequate, isoproterenol or another agent with positive chronotropic properties may be given cautiously. Under some circumstances, transthoracic or transvenous pacemaker placement may be necessary.
Hypotension : Administer IV fluids and vasopressors.
Intravenous glucagon may be useful.
Heart Block (second or third degree): Monitor and treat with isoproterenol infusion. Under some circumstances, transthoracic or transvenous pacemaker placement may be necessary.
Congestive Heart Failure : Initiate therapy with digitalis glycoside and diuretics. In certain cases, consider the use of inotropic and vasodilating agents.
Bronchospasm: Administer bronchodilator therapy such as a short acting inhaled ß 2 -agonist and/or aminophylline.
Hypoglycemia : Administer IV glucose. Repeated doses of IV glucose or possibly glucagon may be required.
Supportive measures should continue until clinical stability is achieved. The half-life of low doses of Od-Neb is 12-19 hours.
Call the National Poison Control Center (800-222-1222) for the most current information on ß-blocker overdose treatment.
What should I avoid while taking Od-Neb?
Od-Neb may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Od-Neb warnings
5.1 Abrupt Cessation of Therapy
Do not abruptly discontinue Od-Neb therapy in patients with coronary artery disease. Severe exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following the abrupt discontinuation of therapy with ß-blockers. Myocardial infarction and ventricular arrhythmias may occur with or without preceding exacerbation of the angina pectoris. Caution patients without overt coronary artery disease against interruption or abrupt discontinuation of therapy. As with other ß-blockers, when discontinuation of Od-Neb is planned, carefully observe and advise patients to minimize physical activity. Taper Od-Neb over 1 to 2 weeks when possible. If the angina worsens or acute coronary insufficiency develops, re-start Od-Neb promptly, at least temporarily.
5.2 Angina and Acute Myocardial Infarction
Od-Neb was not studied in patients with angina pectoris or who had a recent MI.
5.3 Bronchospastic Diseases
In general, patients with bronchospastic diseases should not receive ß-blockers.
5.4 Anesthesia and Major Surgery
Because beta-blocker withdrawal has been associated with an increased risk of MI and chest pain, patients already on beta-blockers should generally continue treatment throughout the perioperative period. If Od-Neb is to be continued perioperatively, monitor patients closely when anesthetic agents which depress myocardial function, such as ether, cyclopropane, and trichloroethylene, are used. If ß-blocking therapy is withdrawn prior to major surgery, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
The ß-blocking effects of Od-Neb can be reversed by ß-agonists, e.g., dobutamine or isoproterenol. However, such patients may be subject to protracted severe hypotension. Additionally, difficulty in restarting and maintaining the heartbeat has been reported with ß-blockers.
5.5 Diabetes and Hypoglycemia
ß-blockers may mask some of the manifestations of hypoglycemia, particularly tachycardia. Nonselective ß-blockers may potentiate insulin-induced hypoglycemia and delay recovery of serum glucose levels. It is not known whether Od-Neb has these effects. Advise patients subject to spontaneous hypoglycemia and diabetic patients receiving insulin or oral hypoglycemic agents about these possibilities.
5.6 Thyrotoxicosis
ß-blockers may mask clinical signs of hyperthyroidism, such as tachycardia. Abrupt withdrawal of ß-blockers may be followed by an exacerbation of the symptoms of hyperthyroidism or may precipitate a thyroid storm.
5.7 Peripheral Vascular Disease
ß-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease.
5.8 Non-dihydropyridine Calcium Channel Blockers
Because of significant negative inotropic and chronotropic effects in patients treated with ß-blockers and calcium channel blockers of the verapamil and diltiazem type, monitor the ECG and blood pressure in patients treated concomitantly with these agents.
5.9 Use with CYP2D6 Inhibitors
Od-Neb exposure increases with inhibition of CYP2D6. The dose of Od-Neb may need to be reduced.
5.10 Impaired Renal Function
Renal clearance of Od-Neb is decreased in patients with severe renal impairment. Od-Neb has not been studied in patients receiving dialysis.
5.11 Impaired Hepatic Function
Metabolism of Od-Neb is decreased in patients with moderate hepatic impairment. Od-Neb has not been studied in patients with severe hepatic impairment.
5.12 Risk of Anaphylactic Reactions
While taking ß-blockers, patients with a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated accidental, diagnostic, or therapeutic challenge. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reactions.
5.13 Pheochromocytoma
In patients with known or suspected pheochromocytoma, initiate an a-blocker prior to the use of any ß-blocker.
What should I discuss with my healthcare provider before taking Od-Neb?
To make sure you can safely take Od-Neb, tell your doctor if you have any of these other conditions:
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severe liver disease; or
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a heart problem such as heart block, sick sinus syndrome, slow heart rate, or heart failure.
If you have any of these other conditions, you may need a Od-Neb dose adjustment or special tests:
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asthma, bronchitis, emphysema;
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liver or kidney disease;
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diabetes;
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a thyroid disorder;
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a history of allergies;
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problems with circulation (such as Raynaud's syndrome);
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pheochromocytoma (tumor of the adrenal gland); or
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if you have recently had a heart attack.
FDA pregnancy category C. It is not known whether Od-Neb will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using Od-Neb. It is not known whether Od-Neb passes into breast milk or if it could harm a nursing baby. Do not use Od-Neb without telling your doctor if you are breast-feeding a baby.
Od-Neb precautions
Abnormally slow heartbeat; a type of chest pain due to spontaneously occurring heart cramp called Prinzmetal angina; untreated chronic heart failure; 1st degree heart block (a kind of light heart conduction disorder that affects heart rhythm); poor circulation in the arms or legs eg, Raynaud's disease or syndrome, cramp-like pains when walking; prolonged breathing problems; diabetes: Od-Neb has no effect on blood sugar but it could conceal the warning signs of a low sugar level eg, palpitations, fast heartbeat; overactive thyroid gland: Od-Neb may mask the signs of an abnormally fast heart rate due to this condition; allergy: Od-Neb may intensify the reaction to pollen or other substances allergic to; history or presence of psoriasis (skin diseased characterized by scaly skin patches).
If patient has to have surgery, always inform the anaesthetist that patient is on Od-Neb before being anaesthetised.
If with serious kidney problems, do not take Od-Neb for heart failure.
Have regular monitoring by an experienced physician, at the beginning of treatment for chronic heart failure. Treatment should not be stopped abruptly unless clearly indicated and evaluated by the physician.
Forgetting to Take Od-Neb: If patient forgets a dose of Od-Neb but remembers a little later on, take the day's dose as usual. However, if a long delay has occurred eg, several hrs, so that the next due dose is near, skip the forgotten dose and take the next scheduled normal dose at the usual time. Do not take a double dose. Repeated skipping, however, should be avoided.
Discontinuation of Taking Od-Neb: Physician should be consulted whether patient is taking it for high blood pressure or chronic heart failure.
Od-Neb treatment should not be stopped abruptly as it can temporarily make the heart failure worse. If it is necessary to stop Od-Neb treatment for chronic heart failure, the daily dose should be decreased gradually by halving the dose at weekly intervals.
Effects on the Ability to Drive or Operate Machinery: Od-Neb may cause dizziness or fatigue. If affected, do not drive or operate machinery.
Use in pregnancy & lactation: Od-Neb should not be used during pregnancy unless clearly necessary.
It is not recommended for use while breastfeeding.
Use in children: Because of the lack of data on the use of Od-Neb in children & adolescents, it is not recommended for use in them.
What happens if I miss a dose of Od-Neb?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
References
- DrugBank. "Nebivolol". http://www.drugbank.ca/drugs/DB04861 (accessed September 17, 2018).
- MeSH. "Adrenergic beta-1 Receptor Agonists". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
