CARVEDILOL

Non-selective beta and alpha-1 blocker with an arteriolar vasodilating action

Dosage Forms

▼

Tablet

6.25mg
12.5mg

Uses

▼
  • Stable heart failure due to left ventricular systolic dysfunction
  • Hypertension
  • Angina

Dose and Duration

▼
Hypertension
Adult:12.5 mg once a day increased after 2 days to the usual dose of 25 mg once a day. Dose may be increased as is required every 2 weeks up to a maximum dose of 25 mg every 12 hours
Elderly:initially 12.5 mg once a day and the dose adjusted according to response at intervals of 2 weeks or more
Angina
Adult: initially, 12.5 mg every 12 hours increased after 2 days to 25 mg every 12 hours (max 50 mg every 12 hours)
Elderly:12.5 mg every 12 hours increased after 2 days to a maximum dose of 25 mg every 12 hours
Heart failure (adjunct therapy)
Adult: initially, 3.125 mg every 12 hours; increased at intervals of 2 weeks up to 6.25 mg every 12 hours (max 25 mg every 12 hours in severe heart or body weight < 85 kg and 50 mg every 12 hours in patients > 85 kg)
Child 2 -18 years: initially 0.05 mg/kg (max 3.125 mg) every 12 hours, doubled at intervals of at least 2 weeks up to 0.35 mg/kg (max 25 mg) every 12 hours

Contraindications

▼
  • Acute or decompensated heart failure requiring intravenous inotropes
  • Chronic obstructive pulmonary disease with bronchial obstruction
  • Clinically significant hepatic dysfunction
  • Bronchial asthma
  • Prinzmetal’s angina
  • Marked bradycardia (< 50 bpm)
  • Severe hypotension (systolic BP below 85 mmHg)
  • Sick sinus syndrome
  • 2nd and 3rd degree atrio-ventricular block (unless a permanent pacemaker is in place)
  • Cardiogenic shock
  • Metabolic acidosis
  • Severe peripheral arterial disease
  • Untreated pheochromocytoma
  • Hypersensitivity to carvedilol

Side Effects

▼
  • Bronchitis, pneumonia, upper respiratory tract infection
  • Urinary tract infection, micturition abnormalities
  • Hypercholesterolemia, anaemia, impaired glucose control in patients with pre-existing diabetes
  • Depression, dizziness, headache
  • Visual impairment, decreased lacrimation, eye irritation
  • Cardiac failure, bradycardia, hypotension
  • Oedema, hypervolemia, fluid overload
  • Visual disturbance
  • Ototoxicity
  • CDyspnoea, pulmonary oedema, asthma in predisposed patients
  • Nausea, diarrhoea, vomiting, dyspepsia, abdominal pain
  • Pain in extremities, pain, fatigue
  • Renal failure and renal function abnormalities

Interactions

▼
  • Adrenaline, dobutamine (increased risk of severe hypertension and bradycardia)
  • Ciclosporin (plasma concentration of ciclosporin increased)
  • Clonidine (increased risk of withdrawal hypertension)
  • Prazosin, alfuzosin (enhanced hypotensive effect)
  • Amiodarone, flecainide (increased risk of bradycardia, atrio-ventricular block and myocardial depression)
  • Nifedipine (risk of severe hypotension and heart failure)
  • Diltiazem (increased risk of AV block and bradycardia)
  • Verapamil (increased risk of asystole, severe hypotension and heart failure)

Patient Instructions

▼
  • Take your medication for heart failure with food and enough water
  • Do not drive or operate heavy or dangerous machinery if you feel dizzy

Pregnancy

▼
  • Do not use

Breastfeeding

▼
  • Do not use

⚠️ Caution

▼
  • Avoid abrupt withdrawal of carvedilol. Withdraw gradual ly over 2 weeks
  • When clonidine and carvedilol are used together, with draw carvedilol several days before slow withdrawal of clonidine
  • Monitor renal function during dose titration in heart failure patients who also have renal impairment, low blood pressure, ischaemic heart disease or vascular disease
  • Carvedilol may mask symptoms of thyrotoxicosis, acute hypoglycaemia hence need for close monitoring of diabetics also using carvedilol
  • Reduce dose of carvedilol if bradycardia occurs
  • Carvedilol may aggravate or exacerbate skin symptoms in patients with psoriasis
  • Carvedilol reduces placental perfusion hence severe ad verse foetal consequences in the neonate. Only use if necessary and stop treatment 2–3 days before expected birth and monitor new-born for the first 2–3 days of life