Pharm
Carvedilol
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Carvedilol
, Coreg
See Also
Beta Blocker
Beta Blocker Overdose
Indication
Stable
Congestive Heart Failure
(Compensated)
Mechanism
Third generation
Beta Blocker
(vasodilatory properties)
Beta Adrenergic Receptor
Antagonist
Non-selective
Beta Blocker
Vasodilator (alpha antagonist)
Blunts sympathetic drive
Preserves some heart function
Does not affect
Blood Glucose
Dosing
Stable
Congestive Heart Failure
Start: 3.125 mg PO bid with food
Titrate up by doubling dose every 2 weeks
Maximum dose
Weight <85 kg: 25 mg bid
Weight >85 kg: 50 mg bid
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
Abraham (2003) Congest Heart Fail 9:251-8 [PubMed]
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
Packer (1996) N Engl J Med 334:1349-55 [PubMed]
Utah Study of Carvedilol in CHF
Ejection Fraction improved 20% to 33%
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