Bystolic is a beta-blocker used to lower high blood pressure. Because beta-blockers affect heart rate and cardiovascular responses, stopping treatment suddenly can sometimes cause important problems.
Bystolic is the brand name for nebivolol, a prescription beta-blocker approved in the United States to treat high blood pressure. Palpitations can sometimes occur after a beta-blocker dose is reduced or stopped, particularly if treatment is stopped abruptly. However, palpitations during dose reduction are not automatically caused by withdrawal. The original condition, changing blood pressure or heart rate, another medicine, or an arrhythmia may also be responsible. Do not use a generic online taper schedule. Your prescriber should decide how your dose is reduced.
Do Not Stop Bystolic Suddenly Without Medical Advice
The official prescribing information warns against abruptly discontinuing Bystolic, particularly in people with coronary artery disease.
Severe worsening of angina, myocardial infarction and ventricular arrhythmias have been reported after abrupt withdrawal of beta-blocker therapy in patients with coronary disease.
The label also cautions people without known coronary artery disease against suddenly interrupting treatment.
When Bystolic is being discontinued, the prescribing information recommends tapering it over approximately 1 to 2 weeks when possible. This does not mean everyone should follow the same dose-reduction steps. The exact taper should be determined by the clinician who knows why you take the medicine, your current dose, blood pressure, pulse, other medicines and cardiovascular history.
What Is Bystolic?
Bystolic is a brand name for nebivolol, a prescription medicine belonging to the beta-blocker class.
Beta-blockers reduce the effects of sympathetic stimulation on the cardiovascular system. Nebivolol lowers heart rate and helps lower blood pressure through its cardiovascular effects.
Like other medicines that influence heart rate and blood pressure, nebivolol should be taken according to the prescription rather than started, stopped or adjusted independently.
What Is Bystolic Used For?
In the current United States prescribing information, Bystolic is indicated for the treatment of hypertension (high blood pressure).
It can be used alone or together with other antihypertensive medicines. Reducing elevated blood pressure is an important part of lowering long-term cardiovascular risk.
Important Medication Correction
Older information on this page stated that Bystolic was routinely used to treat atrial fibrillation, heart failure and angina and to prevent another heart attack.
These should not be presented as standard U.S. labeled indications for Bystolic. Beta-blockers as a drug class are used for several cardiovascular conditions, and clinicians may sometimes use particular medicines for additional indications depending on the patient and country. However, the current U.S. Bystolic label specifically lists hypertension as its indication and states that Bystolic was not studied in patients with angina pectoris or a recent myocardial infarction.
How Does Nebivolol Affect the Heart?
Nebivolol blocks beta-adrenergic signaling and can slow the heart rate. This is one reason your pulse may be lower while taking the medicine than it would be without beta-blockade.
Because the cardiovascular system adapts during ongoing beta-blocker treatment, abruptly removing that effect can sometimes lead to an increase in heart rate, blood pressure or cardiac symptoms.
This is why stopping a beta-blocker deserves more caution than simply missing a routine tablet.
If your concern is an unusually slow heartbeat while taking treatment, our guide to bradycardia and palpitations explains the relationship between slow heart rate and heartbeat sensations.
Why Might I Have Palpitations While Reducing or Stopping Bystolic?
Some people notice a faster or stronger heartbeat after a beta-blocker dose is reduced. This may feel like racing, pounding, fluttering or increased awareness of the heartbeat.
Several explanations are possible.
Changing beta-blockade
Removing or reducing beta-blockade can allow heart rate and sympathetic cardiovascular responses to increase compared with the medicated state. In susceptible people this may be experienced as palpitations.
Return of the original condition
Blood pressure may begin moving back toward its pretreatment level after an antihypertensive medicine is withdrawn. If the beta-blocker was also suppressing a fast heartbeat, that tendency may become noticeable again.
Premature beats or another arrhythmia
A palpitation does not identify the underlying rhythm. Premature atrial or ventricular beats, sinus tachycardia, atrial fibrillation or another arrhythmia may produce similar sensations.
Other triggers
Anxiety, caffeine, nicotine, dehydration, thyroid disease, anemia, other medicines and many additional factors can cause or intensify palpitations at the same time a medication is being changed.
A clinical trial examining nebivolol withdrawal in patients treated for uncomplicated hypertension found blood pressure moving back toward pretreatment levels without a clear rebound syndrome in the study population. That does not eliminate the recognized risks of abrupt beta-blocker withdrawal, particularly in patients with coronary disease, but it does mean that statements such as “palpitations are very common whenever Bystolic is stopped” are too strong.
See our broader guide to causes and triggers of heart palpitations for other possibilities.
How Should Bystolic Be Stopped?
There is no single taper schedule that is appropriate for every patient.
The U.S. prescribing information advises tapering Bystolic over approximately 1 to 2 weeks when possible. However, the label does not provide a universal percentage-by-percentage schedule for every patient.
Your clinician may need to consider:
- your current nebivolol dose;
- how long you have taken it;
- why it was prescribed;
- your resting blood pressure;
- your resting heart rate;
- whether you have coronary artery disease;
- whether you have a history of arrhythmia;
- other blood-pressure or heart-rate medicines;
- kidney and liver function when clinically relevant; and
- how you respond as the dose changes.
Do Not Use the Old 25% Taper Formula
This page previously instructed readers to take 75% of their dose, then 50%, then 25%, and finally stop.
That schedule has been removed because it is not an individualized medical plan and may not be practical or appropriate for the particular tablets being used.
Brand BYSTOLIC tablets are supplied in multiple strengths and are unscored. Do not assume that tablets should be quartered or split into arbitrary percentages unless your doctor or pharmacist has specifically confirmed an appropriate plan for your medication.
What Should You Monitor During a Medication Change?
Your healthcare professional may ask you to monitor your blood pressure and pulse during a dose reduction.
Useful information to record can include:
- blood pressure readings;
- resting heart rate;
- the time each dose is taken;
- when palpitations occur;
- how long they last;
- whether the heartbeat feels regular or irregular;
- chest discomfort;
- dizziness or near-fainting;
- shortness of breath; and
- any new medicines, caffeine or stimulant exposure.
The American Heart Association notes that patients taking beta-blockers may be asked to monitor their heart rate so their healthcare professional can assess whether the dose or medication needs adjustment.
If palpitations persist, your clinician may consider an ECG or ambulatory rhythm monitor rather than assuming that every episode is simply a withdrawal symptom.
Learn more in our guide to heart palpitation symptoms.
Who Needs Particular Caution With Bystolic?
The prescribing information lists important contraindications and precautions. These are some examples rather than a substitute for the full medication label.
Bystolic is contraindicated in certain patients with:
- severe bradycardia;
- heart block greater than first degree;
- cardiogenic shock;
- decompensated cardiac failure;
- sick sinus syndrome unless a permanent pacemaker is present;
- severe hepatic impairment; or
- hypersensitivity to a component of the medicine.
Other situations requiring particular medical consideration include:
- bronchospastic lung disease;
- diabetes or risk of hypoglycemia;
- hyperthyroidism or thyrotoxicosis;
- peripheral vascular disease;
- significant kidney impairment;
- liver impairment;
- pheochromocytoma;
- planned surgery or anesthesia; and
- use of medicines that also slow heart rate or interact with nebivolol.
Verapamil, diltiazem, digoxin and some antiarrhythmic medicines can add to heart-rate or conduction effects. Certain CYP2D6 inhibitors, including some antidepressants and antiarrhythmics, can increase nebivolol exposure. Always provide your doctor or pharmacist with an up-to-date medication list.
Dr. Albana’s Note
When someone develops palpitations while reducing a beta-blocker, I do not assume immediately that the medicine is the only explanation. I want to know the original reason for treatment, the previous and current dose, blood pressure, pulse, how quickly the dose was changed and exactly what the heartbeat feels like. I also look for warning symptoms such as chest discomfort, fainting or significant breathlessness. The safest approach is to adjust beta-blocker treatment with the prescribing clinician rather than following a fixed taper found online.
What Should You Do If Palpitations Start During the Taper?
If symptoms are mild but new or recurring, contact the clinician managing your medication. They may need to review your taper, blood pressure, pulse, medication interactions or the reason you were taking nebivolol.
Do not automatically:
- take an extra tablet;
- double the next dose;
- restart an old dose on your own;
- stop the remaining medicine abruptly;
- split tablets into arbitrary percentages; or
- assume the symptoms are harmless withdrawal effects.
If palpitations remain frequent, see our constant and frequent palpitations guide.
When Are Palpitations After Stopping Bystolic an Emergency?
Seek urgent or emergency medical care if palpitations occur with:
- chest pain, pressure or significant tightness;
- fainting or loss of consciousness;
- collapse;
- severe shortness of breath;
- severe dizziness or near-fainting;
- a sustained very rapid or markedly irregular heartbeat;
- severe or rapidly worsening weakness;
- new neurologic symptoms; or
- other rapidly worsening cardiovascular symptoms.
Chest pain following abrupt beta-blocker withdrawal deserves particular attention, especially in someone with known or possible coronary artery disease. Do not wait for the symptoms to settle before obtaining emergency assessment.
Most Asked Questions
What is Bystolic used for?
In the current U.S. prescribing information, Bystolic (nebivolol) is indicated for the treatment of high blood pressure. It can be used alone or with other antihypertensive medicines.
Can stopping Bystolic cause heart palpitations?
Palpitations can occur after beta-blocker reduction or withdrawal in some people because heart rate and sympathetic cardiovascular responses may increase. However, palpitations are not inevitable and should not automatically be attributed to withdrawal without considering other possible causes.
Can I stop Bystolic suddenly?
Abrupt discontinuation is generally discouraged. The official prescribing information warns particularly about abrupt withdrawal in people with coronary artery disease and recommends tapering over approximately 1 to 2 weeks when possible. Your clinician should determine the actual dose-reduction plan.
How slowly should Bystolic be tapered?
The U.S. label recommends tapering over approximately 1 to 2 weeks when possible, but it does not provide one universal percentage schedule for everyone. The exact dose changes should be individualized by the prescribing clinician.
Should I cut my Bystolic tablets into quarters?
Do not assume that quartering the tablet is appropriate. Brand BYSTOLIC tablets are unscored, and different nebivolol products may have different tablet designs. Ask your doctor or pharmacist how the prescribed taper should be carried out.
Will everyone get withdrawal symptoms from nebivolol?
No. Individual responses differ. A clinical study of nebivolol withdrawal in patients with uncomplicated hypertension found blood pressure returning toward pretreatment levels without a clear rebound syndrome. Nevertheless, beta-blocker withdrawal can be clinically important in certain patients, particularly those with coronary disease.
Can blood pressure rise after stopping Bystolic?
Yes. If Bystolic has been lowering your blood pressure, blood pressure may move back toward its untreated level after the medicine is reduced or stopped. This is one reason blood pressure monitoring may be appropriate during a clinician-supervised medication change.
What if my heart rate becomes fast after reducing Bystolic?
Contact the clinician managing your treatment, particularly if the change is substantial, persistent or associated with other symptoms. Seek urgent care for a very rapid heartbeat accompanied by chest pain, severe shortness of breath, severe dizziness, fainting or significant weakness.
Related Heart Palpitation Guides
Medical References
- DailyMed. BYSTOLIC (nebivolol hydrochloride) tablets — Full Prescribing Information. Revised August 2024. U.S. National Library of Medicine / DailyMed .
- DailyMed. Nebivolol Tablets — Prescribing Information. Current U.S. generic labeling. DailyMed .
- Lewin A, Lasseter KC, Dong F, Whalen JC. Nebivolol Withdrawal Results in Blood Pressure Returning Toward Pretreatment Levels, but Without Rebound Symptoms: Phase IV Randomized Trial. J Am Soc Hypertens. 2012;6(3):228-236. PubMed .
- Stojanovic M, et al. Beta Blocker Rebound Phenomenon Is Important, but We Do Not Know Its Definition, Incidence or Optimal Prevention Strategies. Hypertens Res. 2020. PubMed .
- American Heart Association. All About Heart Rate (Pulse). Last reviewed May 2024. American Heart Association .
About the Medical Team
Dr. Albana Greca, MBBS, MMedSc
Family Physician / General Practitioner
Dr. Albana Greca has more than 20 years of experience in primary care, general medicine, chronic disease management, prevention, patient education and digital health.
Dr. Benard Shehu, MBBS, MS
Cardiologist
Dr. Benard Shehu has more than 19 years of cardiovascular experience, including clinical experience relevant to arrhythmias and cardiovascular disease.