II. Indication

  1. Stable Congestive Heart Failure (Compensated)
  2. Hypertension

III. Contraindications

IV. Mechanism

  1. Combination of classes ("Third generation Beta Blocker", similar to Labetalol)
    1. Lowers Blood Pressure without reflex Tachycardia
    2. Nonselective Beta Blocker
      1. Binds vascular (and Bronchial) smooth muscle beta receptors
      2. Decreases Heart Rate, Cardiac Output and Blood Pressure
      3. Blunts sympathetic drive while still preserving cardiac contractility
    3. Selective Alpha-1 Adrenergic Antagonist (weak compared with beta activity)
      1. Competitively binds vascular smooth muscle alpha-1 Adrenergic Receptors
      2. Blocks peripheral blood vessel Vasoconstriction
  2. Other effects
    1. Does not affect Blood Glucose

V. Dosing: Carvedilol Regular Release (Coreg)

  1. Stable Congestive Heart Failure
    1. Start: 3.125 mg orally twice daily 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
  2. Hypertension
    1. Start: 6.25 orally twice daily with food
    2. Double dose as needed every 7-14 days to maximum of 25 mg orally twice daily
  3. 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 [PubMed]

VI. Dosing: Carvedilol Sustained Release (Coreg CR)

  1. Stable Congestive Heart Failure
    1. Start: 10 mg orally daily
    2. Titrate up by doubling dose every 2 weeks as needed
    3. Maximum dose: 80 mg/day
  2. Hypertension
    1. Start: 20 mg orally daily
    2. Titrate up by doubling dose every 2 weeks as needed
    3. Maximum dose: 80 mg/day

VII. 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 [PubMed]
  2. Utah Study of Carvedilol in CHF
    1. Ejection Fraction improved 20% to 33%

VIII. Adverse Effects

IX. Drug Interactions

  1. Systemic Beta Agonists
    1. Carvedilol blocks bronchodilation

X. References

  1. Olson (2020) Clinical Pharmacology, MedMaster, Miami, p. 66
  2. Hamilton (2020) Tarascon Pocket Pharmacopeia, Jones and Bartlett, accessed on IOS, 4/9/2021

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

Carvedilol (on 6/18/2017 at Walmart.com)
Carvedilol 12.5mg #60 tablets for $4.00 $0.07 each
Carvedilol 12.5mg #180 tablets for $10.00 $0.06 each
Carvedilol 25mg #60 tablets for $4.00 $0.07 each
Carvedilol 25mg #180 tablets for $10.00 $0.06 each
Carvedilol 3.125mg #60 tablets for $4.00 $0.07 each
Carvedilol 3.125mg #180 tablets for $10.00 $0.06 each
Carvedilol 6.25mg #60 tablets for $4.00 $0.07 each
Carvedilol 6.25mg #180 tablets for $10.00 $0.06 each
carvedilol (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
CARVEDILOL 12.5 MG TABLET Generic $0.03 each
CARVEDILOL 25 MG TABLET Generic $0.03 each
CARVEDILOL 3.125 MG TABLET Generic $0.03 each
CARVEDILOL 6.25 MG TABLET Generic $0.02 each
coreg (on 2/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
COREG 12.5 MG TABLET Generic $0.03 each
COREG 25 MG TABLET Generic $0.03 each
COREG 3.125 MG TABLET Generic $0.03 each
COREG 6.25 MG TABLET Generic $0.02 each
COREG CR 10 MG CAPSULE $8.82 each
COREG CR 20 MG CAPSULE $8.81 each
COREG CR 40 MG CAPSULE $8.80 each
COREG CR 80 MG CAPSULE $8.83 each

Ontology: carvedilol (C0054836)

Definition (NCI_NCI-GLOSS) A drug used to treat high blood pressure and certain heart problems. It is also being studied in the prevention and treatment of side effects caused by some anticancer drugs. Coreg blocks certain receptors on nerve cells and causes blood vessels to dilate (widen). It is a type of antihypertensive agent and a type of antianginal agent.
Definition (NCI) A synthetic antihypertensive methoxyphenoxy- 2-propanol derivative with no intrinsic sympathomimetic activity, Carvedilol acts as a nonselective beta-adrenoceptor blocking agent (S(-) enantiomer) and as an alpha 1-adrenoceptor blocker (R(+) and S(-) enantiomers). Its acts more strongly on beta-receptors than on alpha 1-receptors, reduces peripheral vascular resistance by vasodilation, and prevents reflex tachycardia (beta-blockade) so that heart rate is either unchanged or decreased. Carvedilol also reduces renin release through beta-blockade. (NCI04)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C043211
SnomedCT 108551001, 386870007
LNC LP171650-7
English carvedilol, CARVEDILOL, carvedilol (medication), carvedilol [Chemical/Ingredient], Carvedilol, Carvedilol (product), Carvedilol (substance)
Spanish carvedilol (producto), carvedilol (sustancia), carvedilol

Ontology: Coreg (C0719509)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C043211
English Coreg, coreg, GlaxoSmithKline brand of carvedilol