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Carvedilol

CARVEDILOL

Manufacturer: A-S Medication Solutions

Score: 145.0

Quick Summary

Carvedilol is a nonselective β-adrenergic blocking agent with α1-blocking activity, used to treat mild to severe chronic heart failure, left ventricular dysfunction following myocardial infarction, and hypertension. It works by reducing blood pressure, heart rate, and the heart's workload. The drug has various clinical benefits, including improved survival and reduced risk of hospitalization in heart failure patients. However, it also has important safety information, such as contraindications in bronchial asthma, severe bradycardia, and sick sinus syndrome, as well as potential adverse reactions like dizziness, fatigue, and hypotension.

Key Clinical Findings and Indications

  • Treatment of mild to severe chronic heart failure
  • Left ventricular dysfunction following myocardial infarction
  • Hypertension

Important Safety Information

Warning

Carvedilol can cause dizziness, lightheadedness, and fainting, especially when standing up from a lying down or sitting position

Contraindications

  • Bronchial asthma or related bronchospastic conditions
  • Second- or third-degree AV block
  • Sick sinus syndrome
  • Severe bradycardia
  • Patients in cardiogenic shock or decompensated heart failure requiring the use of IV inotropic therapy
  • Severe hepatic impairment
  • History of serious hypersensitivity reaction

Adverse Reactions

  • Dizziness
  • Fatigue
  • Hypotension
  • Diarrhea
  • Hyperglycemia
  • Asthenia
  • Bradycardia
  • Weight increase

Dosing Recommendations

General Guidance

Dose adjustments may be necessary in patients with hepatic impairment or those taking other medications that interact with carvedilol

Heart failure

Adult Dose

Start at 3.125 mg twice daily and increase to 6.25, 12.5, and then 25 mg twice daily over intervals of at least 2 weeks

Pediatric Dose

Not established

Left ventricular dysfunction following myocardial infarction

Adult Dose

Start at 6.25 mg twice daily and increase to 12.5 mg then 25 mg twice daily after intervals of 3 to 10 days

Pediatric Dose

Not established

Hypertension

Adult Dose

Start at 6.25 mg twice daily and increase if needed for blood pressure control to 12.5 mg and then 25 mg twice daily over intervals of 1 to 2 weeks

Pediatric Dose

Not established

Special Population Considerations

Pregnancy

  • There are no data on the presence of carvedilol in human milk
  • The use of beta blockers during the third trimester of pregnancy may increase the risk of hypotension, bradycardia, hypoglycemia, and respiratory depression in the neonate

Nursing Mothers

  • Carvedilol is present in the milk of lactating rats
  • The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for carvedilol and any potential adverse effects on the breastfed infant

Pediatric Use

  • Effectiveness of carvedilol in patients younger than 18 years has not been established
  • In a double-blind trial, 161 children with chronic heart failure were treated with carvedilol, but no significant effect on clinical outcomes was observed

Geriatric Use

  • Of the 765 subjects with heart failure randomized to carvedilol in US clinical trials, 31% were aged 65 years or older
  • No overall differences in the safety or effectiveness of carvedilol were observed between older and younger subjects