Class: α/β-Adrenergic Blocker
Dosage Forms. Tablet: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg; Capsule, Extended Release: 10 mg, 20 mg, 40 mg, 80 mg
Common FDA Label Indication, Dosing, and Titration.
1. Heart failure: Tablets, 3.125 mg po bid, max 25 mg po bid for patients weighing <85 kg, 50 mg po bid for patients weighing >85 kg; Extended-release capsule, 10 mg po daily in the morning, max 80 mg po daily
2. Hypertension: Tablet, 6.25 mg po bid; max 25 mg po bid; Extended-release capsule, 20 mg po daily in the morning, max 80 mg po daily
3. Impaired left ventricular function, myocardial infarction: Tablet, 6.25 mg po bid, may titrate to 25 mg po bid; Extended-release capsule, 10-20 mg po daily in the morning, max 80 mg po daily
Off-Label Uses.
1. Angina pectoris: 25-50 mg po bid
2. Cardiac dysrhythmia: 6.25 mg po bid, may titrate to 25-50 mg po bid
MOA. Carvedilol is a selective alpha-1 and nonselective β-adrenergic blocker that decreases AV nodal conduction in supraventricular tachycardias and blockade of catecholamine-induced dysrhythmias.
Drug Characteristics: Carvedilol
Medication Safety Issues: Carvedilol
Drug Interactions: Carvedilol
Adverse Reactions: Carvedilol
Efficacy Monitoring Parameters. Decreased BP, reduction of chest pain, decreased number of weekly angina attacks, reduction in use of prophylactic nitroglycerin to relieve chest pain, improvement in signs/symptoms of CHF.
Toxicity Monitoring Parameters. Signs/symptoms of heart failure, decreased heart rate, bronchospasm, increased blood glucose levels in diabetic patients, and hepatotoxicity.
Key Patient Counseling Points. Take carvedilol with food or milk. Report signs/symptoms of heart failure, bradyarrhythmias, bronchospasm, hepatotoxicity, hypotension, syncope, or exacerbation of angina with initial dosing and dose changes. Avoid alcohol. Avoid abrupt discontinuation, may cause rebound hypertension. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert. Diabetic patients carefully follow blood sugar levels as β-blockers may mask symptoms of hypoglycemia.
Clinical Pearls. Safety and efficacy not established in pediatric patients.