Carvedilol

Aka: Carvedilol, Coreg

1. See Also
   1. Beta Blocker
   2. Beta Blocker Overdose
2. Indication
   1. Stable Congestive Heart Failure (Compensated)
3. Mechanism: Third generation Beta Blocker (vasodilatory properties)
   1. Beta Adrenergic Receptor Antagonist
      1. Non-selective Beta Blocker
      2. Vasodilator (alpha antagonist)
   2. Blunts sympathetic drive
   3. Preserves some heart function
   4. Does not affect Blood Glucose
4. Dosing: Stable Congestive Heart Failure
   1. Start: 3.125 mg PO bid with food
   2. Titrate up by doubling dose every 2 weeks
   3. Maximum dose
      1. Weight <85 kg: 25 mg bid
      2. Weight >85 kg: 50 mg bid
   4. Conversion from prior Beta Blocker
      1. No overlap from Metoprolol 50 mg or Atenolol 50 mg
         1. Start Carvedilol 6.25 mg bid and increase as above
      2. Overlap from Atenolol 50-150 or Metoprolol 100-200
         1. Add Carvedilol 3.125 mg bid for 2 weeks
         2. Raise Carvedilol and lower other Beta Blocker
            1. Double Carvedilol every two weeks
            2. Reduce Atenolol or Metoprolol by 50 mg q2 weeks
            3. When to stop other Beta Blocker
               1. After 2 weeks on Metoprolol 50 mg or
               2. After 2 weeks on Atenolol 25 mg
                  1. Follows prior 2 weeks on Atenolol 50 mg
         3. Reference
            1. Abraham (2003) Congest Heart Fail 9:251-8
5. Efficacy
   1. Carvedilol used in severe Congestive Heart Failure
      1. Findings
         1. Mean Ejection Fraction: 23%
         2. Studied over 6 months
         3. Overall mortality reduced (3.2% vs 7.8%)
      2. Reference
         1. Packer (1996) N Engl J Med 334:1349-55
   2. Utah Study of Carvedilol in CHF
      1. Ejection Fraction improved 20% to 33%