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Carvedilol

    Brands

    DEA Class;  Rx

    Common Brand Names; Coreg, Coreg CR

    • Beta-Blockers, Alpha Activity

    Oral nonselective beta-blocker with alpha-1-blocking properties; greater ratio of beta- to alpha-1 blocking effects; lipophilic beta-blocker; lacks ISA; indicated for HTN, post-MI, and CHF (improved morbidity and mortality in CHF, cardiomyopathy, and post-MI); off-label uses chronic angina and unstable angina.

    Indicated for the treatment of essential hypertension, either as a single agent or in combination with other antihypertensive agents.

    For the treatment of heart failure (ischemic origin or cardiomyopathy).
    For reduction of cardiovascular mortality and morbidity in stable patients with left ventricular dysfunction (ejection fraction of 40% or higher) following acute myocardial infarction.
    For the treatment of angina.
    For heart rate control in patients with atrial fibrillation or atrial flutter.

    History of serious hypersensitivity reaction (eg, Stevens-Johnson syndrome, anaphylactic reaction, angioedema) to any component of this medication or other medications containing carvedilol

    Bronchial asthma, bronchospasm

    Chronic obstructive pulmonary disease (COPD)

    2°/3° AV block, sick sinus syndrome without permanent pacemaker, cardiogenic shock, severe bradycardia, decompensated heart failure requiring IV inotropic medication

    Severe hepatic impairment

    • Dizziness (2-32%)
    • Fatigue (4-24%)
    • Hypotension (9-20%)
    • Weight gain (10-12%)
    • Hyperglycemia (5-12%)
    • Diarrhea (1-12%)
    • Bradycardia (2-10%)
    • Nausea (2-9%)
    • Cough (5-8%)
    • Headache (5-8%)
    • Atrioventricular block, edema (1-7%)
    • Angina (1-6%)
    • Hpercholesterolemia (1-4%)
    • Hypertriglyceredemia (1%)
    • Vomiting (1-6%)
    • Dyspnea (>3%)
    • Syncope (3%)
    • Rhinitis (2%)
    • Hypertension
    • Palpitations
    • Insomnia
    • Somnolence
    • Skin rash
    • Hepatotoxicity
    • Impotence
    • Bronchospasm
    • Rales
    • Depression

    Use cautioin in anesthesia or surgery (myocardial depression), cerebrovascular insufficiency, diabetes mellitus, hyperthyroidism or thyrotoxicosis, liver disease, peripheral vascular disease (monitor for progression of arterial obstruction), compromised left ventricular function, heart failure, pheochromocytoma, and myasthenia gravis

    Avoid beta-blocker use in non-allergic bronchospasm (e.g., chronic bronchitis and emphysema); if deemed necessary, use with caution and at lowest effective dose

    Combined incidence of hypotension, syncope, or dizziness reported in elderly patients (>65 years) switched from highest dose of immediate-release carvedilol (25 mg q12hr) to extended-release carvedilol 80 mg/day

    When elderly patients are switched from higher doses of immediate-release carvedilol to extended-release carvedilol, a lower starting dose is recommended

    Sudden discontinuance can exacerbate angina and lead to myocardial infarction

    Increased risk of stroke after surgery

    Dosage should be reduced if bradycardia (HR <55 beats/min) develops

    May mask hypoglycemia or hyperthyroidism

    May worsen arterial insufficiency in patients with peripheral vascular disease

    Use caution in patients with mild to moderate hepatic impairment

    Available data in pregnant women are insufficient to determine whether there are drug-associated risks of adverse developmental outcomes; there are risks to mother and fetus associated with poorly controlled hypertension in pregnancy

    There are no data on presence of carvedilol in human milk, effects on breastfed infant, or on milk production

    Adults

    50 mg/day PO regular-release carvedilol for hypertension or post-myocardial infarction; 100 mg/day PO regular-release carvedilol for heart failure; 80 mg/day PO extended-release carvedilol phosphate capsules (Coreg CR) for hypertension, post-myocardial infarction, and heart failure.

    Geriatric

    50 mg/day PO regular-release carvedilol for hypertension or post-myocardial infarction; 100 mg/day PO regular-release carvedilol for heart failure; 80 mg/day PO extended-release carvedilol phosphate capsules (Coreg CR) for hypertension, post-myocardial infarction, and heart failure.

    Adolescents

    Safety and efficacy have not been established; however, a common maximum target dose of 0.8 to 1 mg/kg/day PO (Max: 50 mg/day) using immediate-release tablets has been studied off-label.

    Children

    Safety and efficacy have not been established; however, a common maximum target dose of 0.8 to 1 mg/kg/day PO (Max: 50 mg/day) has been studied off-label.

    Infants

    Safety and efficacy have not been established. A common maximum target dose of 0.8 to 1 mg/kg/day PO is used off-label, and up to 2 mg/kg/day has been reported in one infant.

    Neonates

    Safety and efficacy have not been established.

    Carvedilol phosphate

    capsule, extended release

    • 10mg
    • 20mg
    • 40mg
    • 80mg

    tablet

    • 3.125mg
    • 6.25mg
    • 12.5mg
    • 25mg