Drug Interaction Report

Cimetidine and Nebivolol: Interaction Details

Name: Cimetidine and Nebivolol Interaction
Creator: Dr. Brian Staiger, PharmD, BCPS

A pharmacist-reviewed analysis of the Cimetidine and Nebivolol interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Cimetidine

Tagamet

Nebivolol

Bystolic Bystolic®

Medically reviewed by

Dr. Brian Staiger, PharmD, BCPS

Updated Aug 8, 2026

Editorial policy · Data sources

Interaction severity

Moderate

Can be significant — usually manageable with monitoring.

Minor

Moderate

Major

Contraindicated

How we grade severity & evidence

Severity levels

Contraindicated: These should generally not be used together.
Major: Potentially serious — often needs a change or close monitoring.
Moderate: Can be significant — usually manageable with monitoring.
Minor: Usually limited clinical impact.

Evidence grades

Established: Well documented — supported by controlled studies or strong clinical data.
Probable: Good supporting evidence, though not definitively proven.
Suspected: Some evidence suggests this interaction, but it is not well established.
Possible: Limited or conflicting evidence; the interaction may occur.
Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 83 documented Cimetidine interactions, 22 are rated moderate — including this one.

Onset

unspecified

Evidence

probable

Severity

Moderate

What happens

Increased nebivolol plasma levels

Interaction Deep Dive

Nebivolol is metabolized extensively in the liver¹. Cimetidine appears to act on certain microsomal enzyme systems, thereby reducing the metabolism and increasing levels of hepatically-metabolized drugs, such as lidocaine, phenytoin, and warfarin ². Coadministration of cimetidine 400 mg twice daily with a single 5-mg nebivolol dose led to a 23% increase in the plasma levels of d-nebivolol (pharmacologically active isomer) ¹. Closely monitor blood pressure in patients receiving cimetidine and nebivolol concomitantly.

Why it happens (mechanism)

Altered hepatic metabolism of nebivolol

Common questions

Can I take Cimetidine and Nebivolol together?

Increased nebivolol plasma levels Always confirm with your pharmacist or prescriber before making any change.

How serious is the Cimetidine and Nebivolol interaction?

It is rated moderate. Can be significant — usually manageable with monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

Does my dose of Cimetidine or Nebivolol need adjusting while I take them together?
What symptoms should prompt me to call you or my prescriber right away?
Does the timing of my doses matter for this combination?
Is there anything you'd monitor while I'm on both?

References (2)

Product Information: BYSTOLIC(TM) oral tablets, nebivolol oral tablets. Forest Laboratories,Inc, St.Louis, MO, 2007. DailyMed
Product Information: TAGAMET(R) oral tablets, cimetidine oral tablets. GlaxoSmithKline, Research Triangle Park, NC, 2005. DailyMed

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Cimetidine

Keep reading about Cimetidine

All Cimetidine interactions (83)

Also serious with: Dofetilide Colchicine Octreotide Injection Meloxicam Injection

Nebivolol

Keep reading about Nebivolol

All Nebivolol interactions (220) Nebivolol drug information

Also serious with: Mavorixafor Bupropion Ceritinib Olodaterol Oral Inhalation

Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Cimetidine + Activated Charcoal Pu-erh Tea St. John's Wort Adrafinil African Wild Potato Banderol Beer Bitter Melon + 87 more

Nebivolol + Activated Charcoal American Hellebore American Mistletoe Indian Snakeroot Tyramine 1,3-dmaa Acacia Rigidula Active Hexose Correlated Compound (ahcc) + 175 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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A message from HelloPharmacist

About our interaction database: depth, not breadth

HelloPharmacist doesn't license one of the big commercial interaction databases, so what you'll find here is not a complete list of every known drug interaction. Instead, each entry is researched, analyzed, and written up individually — documented from the published literature, reviewed by a pharmacist, and cited so you can check every source yourself.

If a combination isn't listed here, it means we haven't documented it yet — never that it's safe. For screening a full medication list, we recommend pairing this site with a comprehensive tool like the Drugs.com Interaction Checker and, most importantly, a review by your own pharmacist. For a deep, plain-English, fully sourced explanation of a specific documented interaction — that's exactly what we built this for.

This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.