7 Bystolic Side Effects: Headache, Nausea, and More

If you need help managing your blood pressure, you may be prescribed a medication like Bystolic (nebivolol). It belongs to a class called beta blockers. Beta blockers aren’t usually first-choice medications for high blood pressure, but they can be an alternative or add-on option for certain people.

Beta blockers like Bystolic work by slowing down your heart rate. This can help lower blood pressure, but it can also result in side effects — from headaches to fatigue. Here’s what you should know about Bystolic side effects and how to manage them.

Bystolic side effects at a glance

Most Bystolic side effects are usually mild and can be managed at home. But others, or those that become severe, may require additional assistance from your healthcare team. 

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Potential nebivolol side effects include:

• Headache

• Dizziness

• Fatigue

• Diarrhea

• Nausea

• Sleeping problems

• Shortness of breath

• Chest pain

• Swelling

• Slow heart rate (bradycardia)

• Low blood pressure (hypotension)

Continue reading to find out more about seven Bystolic side effects, tips for managing them, and when to contact your prescriber.

1. Headache

Headaches are the most commonly reported Bystolic side effect. Headaches are possible with any blood pressure medication, especially when you first start treatment. But they tend to improve as your body gets used to the medication. In the meantime, you can also try a few medication-free home remedies.

But if the headaches bother you or don’t go away on their own, check with your prescriber. They may suggest an over-the-counter (OTC) pain reliever for relief, such as acetaminophen (Tylenol).Otherwise, they may try lowering your Bystolic dosage to see if that helps.

If your headaches feel severe, you may need to seek additional help at your local emergency department.

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2. Dizziness

Some people feel dizzy after starting Bystolic. Dizziness can happen as your body is getting used to a lower blood pressure. Even so, it’s a good idea to avoid driving or performing activities where dizziness could cause problems until you know how Bystolic affects you.

Feelings of dizziness should improve over time. But to avoid falls, try to change positions slowly, such as going from sitting to standing. Be sure to have something sturdy to hold onto as you get up. Sit or lie back down until the feeling passes if you feel dizzy.

If you experience dizziness that doesn’t go away or that worsens, talk with your healthcare team right away. It’s possible that your dosage needs to be adjusted.

3. Fatigue

All blood pressure medications, especially beta blockers like Bystolic, can make you feel tired. This may be due to Bystolic’s effects on your blood pressure and heart rate, especially if you take a higher dose.

If you’re feeling fatigued after starting Bystolic, this may improve over time. But there are a few things you can do to help boost your energy. Examples include incorporating more movement into your routine and more heart-healthy foods into your diet. 

Talk to your healthcare team about how to exercise safely while taking Bystolic, since you may tire more easily during your workout. Tell them if your fatigue is severe or persistent so they can determine next steps. 

4. Diarrhea

Some people taking Bystolic during clinical trials reported diarrhea as a side effect. But this was also the case for people who didn’t take Bystolic. But if you experience diarrhea, it should be temporary and resolve on its own.

In the meantime, try to stay hydrated and avoid foods that can worsen diarrhea, such as dairy products and fatty or greasy foods. But if your diarrhea continues or gets worse, you may need to see a healthcare professional. If it’s appropriate for you, they may suggest trying an OTC anti-diarrheal medication.

Keep in mind that diarrhea can have different causes, including other medications. So it’s a good idea to make note of any medication or dietary changes that occurred before your symptoms started.

5. Nausea

Nausea is another potential Bystolic side effect. It often resolves without any treatment as your body gets adjusted to the medication.

You can take Bystolic with or without food. But it may help to take your dose with a small snack or meal if you’ve been taking it on an empty stomach. It’s also a good idea to avoid or minimize foods that can cause or worsen nausea, such as greasy or spicy foods.

If your nausea continues or you start vomiting, contact a prescriber right away. They can determine what’s going on and what you should do to start feeling better.

6. Slowed heart rate

Bystolic works to lower your blood pressure by slowing down your heart rate. While uncommon, it’s possible for your heart rate to slow down too much (called bradycardia). This may be more likely to happen with higher doses or if you take Bystolic with interacting medications.

Bradycardia is usually defined as a heart rate below 60 beats per minute. But your healthcare team may use a different level based on your normal heart rate. So it may be a good idea to discuss your personal heart rate goals before starting treatment.

Bradycardia doesn’t always cause symptoms. But if it does, you may notice symptoms such as:

• Dizziness

• Fatigue

• Shortness of breath

• Chest pain

Tell your prescriber if you develop bradycardia symptoms, or if your heart rate is dropping too low. They may need to adjust your Bystolic dosage.

7. Low blood pressure

It’s also possible for your blood pressure to drop too low while taking Bystolic (called hypotension). This may be more likely to happen if you’re taking it with other medications that lower your blood pressure.

What blood pressure level is considered low for you can depend on your health history and treatment goals. Your prescriber should discuss your personal goals with you. They may also have you check your blood pressure at home. Tell them if your readings are lower than they should be or if you’re feeling dizzy, lightheaded, or weak after starting Bystolic.

If your low blood pressure isn’t improving, or if you also have symptoms such as an abnormally fast or slow heart rate or rapid breathing, seek emergency medical care.

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Written by:

Brian Leonard, PharmD, BCACP, BCGP

Brian Leonard earned his doctorate in pharmacy from the University of Florida College of Pharmacy and is board certified in Ambulatory Care and Geriatric Pharmacy.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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