Why are so many patients prescribed Bystolic when there are much cheaper blood pressure meds?

[Slippers]

I know that Bystolic is one of the 3 beta blockers shown to reduce mortality in heart failure - but carvedilol and metoprolol succinate are also in this category and they are much cheaper. Also, if Bystolic is being used for blood pressure alone (and not heart failure) there are literally dozens of cheaper blood pressure drugs that could be prescribed instead. So why is everyone on Bystolic???? It's not even one of the first line treatments on any guideline that I'm aware of. Are drug reps in doctor's offices the only reason this drug gets prescribed so much? Or is there something I don't know about?

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[WVUPharm2007]

I'm sure the drug reps have something to do with it. But its also unique in that its a vasodilator as well. Without knowing the entire patient history, it's tough to just assume that lazy or inappropriate prescribing has occurred.

Interestingly, because of the vasodilatory effects, some men with hypertension can also see improvements with erectile dysfunction caused by the use of other beta blockers. Which, IMO, is reason enough to use it in those cases.

 

[PharmacistFl12]

Bystolic is longer acting than most beta-blockers and have less of the annoying fatigue and dizzy side effects. My dad was not able to tolerate Metoprolol but when the doctor switched him over to Bystolic, he did not experience any of those side effects.

 

[BidingMyTime]

Also, certain ethinc groups, such as African-Americans respond better to Bystolic than other beta-blockers. You maybe be seeing a lof Bystolic, due to the pt population you serve.

 

[lane one]

I know that Bystolic is one of the 3 beta blockers shown to reduce mortality in heart failure - but carvedilol and metoprolol succinate are also in this category and they are much cheaper. Also, if Bystolic is being used for blood pressure alone (and not heart failure) there are literally dozens of cheaper blood pressure drugs that could be prescribed instead. So why is everyone on Bystolic???? It's not even one of the first line treatments on any guideline that I'm aware of. Are drug reps in doctor's offices the only reason this drug gets prescribed so much? Or is there something I don't know about?

You're thinking of bisoprolol. Bisoprolol, along with carvedilol and metop succ. are the gold standard for heart failure. Bystolic (nebivolol) I believe has better tolerability in the elderly.

 

[Slippers]

You're thinking of bisoprolol. Bisoprolol, along with carvedilol and metop succ. are the gold standard for heart failure. Bystolic (nebivolol) I believe has better tolerability in the elderly.

You are correct. And my bad. So there's actually even LESS reason to prescribe it... unless other alternatives weren't tolerated...

 

[owlegrad]

I am thinking your area has good sales reps because I hardly ever see it. Like...almost never.

 

[VA Hopeful Dr]

I am thinking your area has good sales reps because I hardly ever see it. Like...almost never.

I was going to say because your local doctors are ******, but your approach is more polite

 

[TheBlaah]

I believe bystolic is supposed to be particularly effective in diastolic heart failure patients (or HFpEF as they call it now). This may be in part due to its vasodilatory effects. Last I checked, there weren't too many studies that specifically studied HFpEF, but bystolic had a very large and extensive study (SENIORS) that had a subset of patients who were. So I think it just ended being the default beta blocker for a lot of these patients.

 

[Sabril]

I know that Bystolic is one of the 3 beta blockers shown to reduce mortality in heart failure - but carvedilol and metoprolol succinate are also in this category and they are much cheaper. Also, if Bystolic is being used for blood pressure alone (and not heart failure) there are literally dozens of cheaper blood pressure drugs that could be prescribed instead. So why is everyone on Bystolic???? It's not even one of the first line treatments on any guideline that I'm aware of. Are drug reps in doctor's offices the only reason this drug gets prescribed so much? Or is there something I don't know about?

I think patients ask for it because their friends/tvs/third cousins told them to. Also it can be used for migraine prevention though that is a hell of a price tag. I used to recommend to switch to atenolol to prevent people from going into the donut hole. Though most people's reaction would be like "donut what?" so it was just a wasted effort.

I believe bystolic is supposed to be particularly effective in diastolic heart failure patients (or HFpEF as they call it now). This may be in part due to its vasodilatory effects. Last I checked, there weren't too many studies that specifically studied HFpEF, but bystolic had a very large and extensive study (SENIORS) that had a subset of patients who were. So I think it just ended being the default beta blocker for a lot of these patients.

What are the mainstays of therapy for HFpEF (i know they use everything under the sun to manage the comorbidities but not for HFpEF itself)? I only know of loop diuretics and spironolactone that may be helpful. Thanks

 

[VA Hopeful Dr]

I think patients ask for it because their friends/tvs/third cousins told them to. Also it can be used for migraine prevention though that is a hell of a price tag. I used to recommend to switch to atenolol to prevent people from going into the doughnut hole. Though most people's reaction would be like "doughnut what?" so it was just a wasted effort.



What are the mainstays of therapy for HFpEF (i know they use everything under the sun to manage the comorbidities but not for HFpEF itself)? I only know of loop diuretics and spironolactone that may be helpful. Thanks

My understanding is that nothing really treats it. You manage comorbidities (as you said), but didn't think there was any direct treatment for it.

 

[radio frequency]

I was going to say because your local doctors are ******, but your approach is more polite

LOL. I think you’re right. My local docs do not prescribe this. I don’t think I’ve ever dispensed it.

 

[VA77]

So we can make 5 figures

 

[TheBlaah]

What are the mainstays of therapy for HFpEF (i know they use everything under the sun to manage the comorbidities but not for HFpEF itself)? I only know of loop diuretics and spironolactone that may be helpful. Thanks

My understanding is that nothing really treats it. You manage comorbidities (as you said), but didn't think there was any direct treatment for it.

Pretty much my understanding of it as well. Besides diuretics, ARBs, or at least candesartan, have been shown to reduce rehospitalizations in the CHARM trial. Cardizem can also be added as well sometimes to help with rate control particularly in patients with co-morbid a-fib. But that's pretty much it as far as I know.

 

[johnpharm01]

I think patients ask for it because their friends/tvs/third cousins told them to. Also it can be used for migraine prevention though that is a hell of a price tag. I used to recommend to switch to atenolol to prevent people from going into the donut hole. Though most people's reaction would be like "donut what?" so it was just a wasted effort.

Donut holes...I love donut holes especially the chocolate ones

 

[Wickett]

It could be worse....I have an elderly patient that pays almost $600 a month out of pocket for brand Lotrel because no one can convince her something cheaper may work just as well for her.

 

[Cleaveland]

Interestingly, because of the vasodilatory effects, some men with hypertension can also see improvements with erectile dysfunction caused by the use of other beta blockers. Which, IMO, is reason enough to use it in those cases.

Really interesting point in regards to ED. I learned something today, thanks to you. I just found a study about Nebivolol and the use for HTN and ED versus other Beta-Blockers from last year.

"Nebivolol has a unique mechanism of action involving release of nitric oxide, resulting in penile vasodilation, which may be beneficial in the male patient with a history of hypertension and ED. Limited short-term studies comparing nebivolol with other beta blockers indicate erectile function did not worsen and may improve."

Nebivolol versus other beta blockers in patients with hypertension and erectile dysfunction

 

[WVUPharm2007]

It could be worse....I have an elderly patient that pays almost $600 a month out of pocket for brand Lotrel because no one can convince her something cheaper may work just as well for her.

I have no sympathy for voluntary ignorance.