II. Indication
- Stable Congestive Heart Failure (Compensated)
- Hypertension
III. Contraindications
IV. Mechanism
- Combination of classes ("Third generation Beta Blocker", similar to Labetalol)
- Lowers Blood Pressure without reflex Tachycardia
- Nonselective Beta Blocker
- Binds vascular (and Bronchial) Smooth Muscle beta receptors
- Decreases Heart Rate, Cardiac Output and Blood Pressure
- Blunts sympathetic drive while still preserving cardiac contractility
- Selective Alpha-1 Adrenergic Antagonist (weak compared with beta activity)
- Competitively binds vascular Smooth Muscle alpha-1 Adrenergic Receptors
- Blocks peripheral blood vessel Vasoconstriction
- Other effects
- Does not affect Blood Glucose
V. Dosing: Carvedilol Regular Release (Coreg)
- Stable Congestive Heart Failure
- Start: 3.125 mg orally twice daily with food
- Titrate up by doubling dose every 2 weeks
- Maximum dose
- Weight <85 kg: 25 mg bid
- Weight >85 kg: 50 mg bid
-
Hypertension
- Start: 6.25 orally twice daily with food
- Double dose as needed every 7-14 days to maximum of 25 mg orally twice daily
- Conversion from prior Beta Blocker
- No overlap from Metoprolol 50 mg or Atenolol 50 mg
- Start Carvedilol 6.25 mg bid and increase as above
- Overlap from Atenolol 50-150 or Metoprolol 100-200
- Add Carvedilol 3.125 mg bid for 2 weeks
- Raise Carvedilol and lower other Beta Blocker
- Double Carvedilol every two weeks
- Reduce Atenolol or Metoprolol by 50 mg q2 weeks
- When to stop other Beta Blocker
- After 2 weeks on Metoprolol 50 mg or
- After 2 weeks on Atenolol 25 mg
- Follows prior 2 weeks on Atenolol 50 mg
- Reference
- No overlap from Metoprolol 50 mg or Atenolol 50 mg
VI. Dosing: Carvedilol Sustained Release (Coreg CR)
- Stable Congestive Heart Failure
- Start: 10 mg orally daily
- Titrate up by doubling dose every 2 weeks as needed
- Maximum dose: 80 mg/day
-
Hypertension
- Start: 20 mg orally daily
- Titrate up by doubling dose every 2 weeks as needed
- Maximum dose: 80 mg/day
VII. Efficacy
- Carvedilol used in severe Congestive Heart Failure
- Findings
- Mean Ejection Fraction: 23%
- Studied over 6 months
- Overall mortality reduced (3.2% vs 7.8%)
- Reference
- Findings
- Utah Study of Carvedilol in CHF
- Ejection Fraction improved 20% to 33%
VIII. Adverse Effects
- May worsen acute exacerbations of Congestive Heart Failure
- Fatigue
- Erectile Dysfunction
- Orthostatic Hypotension
IX. Drug Interactions
- Systemic Beta Agonists
- Carvedilol blocks bronchodilation
X. References
- Olson (2020) Clinical Pharmacology, MedMaster, Miami, p. 66
- Hamilton (2020) Tarascon Pocket Pharmacopeia, Jones and Bartlett, accessed on IOS, 4/9/2021
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