| Hypertensive disease
Bystolic vs CaroSpir
Side-by-side clinical, coverage, and cost comparison for hypertensive disease.Deep comparison between: Bystolic vs Carospir with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsCarospir has a higher rate of injection site reactions vs Bystolic based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Carospir but not Bystolic, including UnitedHealthcare
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Category
Bystolic
Carospir
At A Glance
Oral
Daily
Selective beta-1 blocker
Oral
Daily
Aldosterone antagonist
Indications
- Hypertensive disease
- Heart failure with reduced ejection fraction
- Hypertensive disease
- Edema
Dosing
Hypertensive disease Start at 5 mg once daily, with or without food; increase at 2-week intervals up to 40 mg. In severe renal impairment (ClCr <30 mL/min), start at 2.5 mg once daily. In moderate hepatic impairment (Child-Pugh Class B), start at 2.5 mg once daily.
Heart failure with reduced ejection fraction Initiate at 20 mg once daily; may increase to 37.5 mg once daily as clinically indicated; may reduce to 20 mg every other day if hyperkalemia develops; consider initiating at 10 mg once daily in patients with eGFR 30-50 mL/min/1.73m2.
Hypertensive disease Initiate at 20 to 75 mg daily in single or divided doses; titrate at two-week intervals; doses >75 mg/day generally do not provide additional blood pressure reduction.
Edema Initiate in a hospital setting at 75 mg daily in single or divided doses; titrate slowly; administer for at least five days before increasing dose to obtain desired effect.
Contraindications
- Severe bradycardia
- Heart block greater than first degree
- Cardiogenic shock
- Decompensated cardiac failure
- Sick sinus syndrome (unless a permanent pacemaker is in place)
- Severe hepatic impairment (Child-Pugh >B)
- Hypersensitivity to any component of this product
- Hyperkalemia
- Addison's disease
- Concomitant use of eplerenone
Adverse Reactions
Most common (>=1%) Headache, fatigue, diarrhea, nausea, dizziness, bradycardia, chest pain, peripheral edema, insomnia, dyspnea, rash
Postmarketing Abnormal hepatic function, acute pulmonary edema, acute renal failure, atrioventricular block (second and third degree), bronchospasm, erectile dysfunction, hypersensitivity (urticaria, allergic vasculitis, angioedema), hypotension, myocardial infarction, pruritus, psoriasis, Raynaud's phenomenon, peripheral ischemia/claudication, somnolence, syncope, thrombocytopenia, vertigo, vomiting
Serious Hyperkalemia, hypotension, worsening renal function, electrolyte and metabolic abnormalities, gynecomastia, impaired neurological function or coma in patients with hepatic impairment and cirrhosis with ascites
Postmarketing Gastric bleeding, ulceration, gastritis, nausea, vomiting, diarrhea, gynecomastia, decreased libido, erectile dysfunction, irregular menses, amenorrhea, postmenopausal bleeding, leukopenia, agranulocytosis, thrombocytopenia, fever, urticaria, anaphylactic reactions, vasculitis, hyponatremia, hypovolemia, leg cramps, lethargy, mental confusion, ataxia, dizziness, headache, renal dysfunction, renal failure, Stevens-Johnson Syndrome, toxic epidermal necrolysis, DRESS, alopecia, pruritus, chloasma, cholestatic/hepatocellular toxicity
Pharmacology
Nebivolol is a beta-adrenergic receptor blocking agent; at doses <=10 mg in extensive metabolizers it is preferentially beta1-selective, while in poor metabolizers or at higher doses it inhibits both beta1- and beta2-adrenergic receptors, lacking intrinsic sympathomimetic and membrane-stabilizing activity at therapeutically relevant concentrations.
Aldosterone antagonist; spironolactone and its active metabolites competitively bind aldosterone receptors at the sodium-potassium exchange site in the distal convoluted renal tubule, increasing sodium and water excretion while retaining potassium, exerting diuretic and antihypertensive effects.
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Most Common Insurance
Anthem BCBS
Bystolic
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (4/12) · Qty limit (1/12)
Carospir
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (0/12) · Qty limit (1/12)
UnitedHealthcare
Bystolic
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (1/8)
Carospir
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Bystolic
- Covered on 0 commercial plans
- PA (2/3) · Step Therapy (2/3) · Qty limit (2/3)
Carospir
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Bystolic.
No savings programs available for Carospir.
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BystolicView full Bystolic profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.