Carvedilol: Usage, Side Effects, Dosage, Precautions

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Coreg (carvedilol) is a drug that is commonly used to treat people with congestive heart failure and to lower blood pressure in people with hypertension . It can also be used for other problems such as arrhythmias. Carvedilol is a beta blocker , which means that it stops the hormone adrenaline from working on the heart and blood vessels. Due to the chemistry of this drug, an emergency dose of carvedilol is given to those who have had a heart attack . This is designed to reduce the risk of fatal side effects and prevent further injury. Carvedilol, marketed under the brand name Coreg, is available in tablet and capsule form. An extended version called Coreg CR is available.

Photo by Tim Hale / Getty Images

Applications

The two main approved uses for carvedilol include slowing the progression of congestive heart failure and lowering blood pressure in people with hypertension. Another permitted use is the dose given immediately after a heart attack or myocardial infarction.

This medicine prevents certain hormones from acting on the heart, allowing the cardiovascular system to maintain a regular and balanced state. This balance reduces the overall stress on the heart.

The intensity of the action of carvedilol depends on whether it is taken with food or not. Healthcare providers can train patients taking carvedilol to take their dose with food to reduce the risk of a dangerous drop in blood pressure, also called hypotension. Carvedilol can also cause orthostatic hypotension , a drop in blood pressure when moving from supine to standing. The half-life of carvedilol is usually seven to 10 hours after taking it, and it takes about four half-lives (about 28-40 hours) to be completely eliminated from the body.

Use not indicated on the label

The unauthorized use of carvedilol is intended to treat migraines and vascular headaches. Carvedilol is known to affect the levels of hormones that affect the heart, but these hormone levels also play a role in other parts of the body.

Decreased levels of these hormones affect blood flow through blood vessels in all parts of the body. By reducing the intensity of blood flow, especially around the head and brain, the frequency and intensity of migraines can be reduced.

Although the main approved uses for carvedilol are in treating the heart, there are other heart conditions where carvedilol is used off-label. The use of carvedilol for these purposes has minimal supporting research. One of these unauthorized uses is for chronic or persistent chest pain, as well as acute or unstable chest pain.

Other unauthorized uses for carvedilol include various types of irregular heartbeat, including atrial flutter and atrial fibrillation.

Minimal studies have been conducted regarding the efficacy of the off-label use of carvedilol in children under 18 years of age with congestive heart failure. However, there are recommendations for the dosage of carvedilol in children. Check with your doctor or pharmacist for the latest advice.

Before drinking

All patients must undergo a thorough examination and medical history before prescribing any medication. The patient should inform their healthcare provider of all medications they are currently taking, including vitamins, herbs, and supplements, as well as their allergies and past experiences with medications.

Carvedilol is usually a first-line drug, as it is often first tried for cardiovascular disease. For this reason, a medical history is very important in determining whether you are eligible to take carvedilol.

Be sure to tell your doctor if you have:

  • Any blood flow problem.
  • Diabetes
  • Lung diseases such as asthma
  • Liver disease
  • Kidney disease
  • Low blood pressure
  • Thyroid health

If your healthcare provider has been informed of any of these conditions during your medical history, further tests and analysis will likely be required. The exam may include blood tests to determine the health of the liver and kidneys. Like many medications, people with liver failure should not take carvedilol.

The results of these and other tests will determine if you can take carvedilol. There are no known differences between the brand-name and generic versions of carvedilol.

Precautions and contraindications.

Carvedilol is not recommended for:

  • Kids
  • People with bronchial asthma.
  • Patients with severe liver disease or congestive heart failure requiring intravenous therapy.
  • Patients at risk of anaphylactic reactions or any other sensitivity to beta-blockers.
  • People with significant bradycardia or high-grade AV block

Caution is advised for pregnant and lactating women, but human data is limited.

For people with thyroid, kidney, or liver disease and heart failure: Carvedilol can mask a rapid heart rate in patients with thyroid disease and should be used with caution. Patients with congestive kidney, liver, or heart failure should not use carvedilol in conjunction with second or third degree AV block unless they have a pacemaker. Otherwise, carvedilol can lead to excessive fluid retention and drug build-up in the heart.

Caution should be exercised in patients taking beta-blockers before any surgery , as carvedilol can negatively interact with anesthesia, causing heart failure in some cases.

Patients with psoriasis, depression, or myasthenia gravis may experience increased symptoms after taking beta-blockers, including the spread of psoriasis, muscle weakness, and double vision. Depressed patients experience this due to the effects of beta blockers in the brain.

Elderly patients should take carvedilol with caution . The body's ability to eliminate decreases with age, and carvedilol may not be absorbed properly, causing a build-up in the heart. Patients with diabetes mellitus and heart failure should be closely monitored while taking carvedilol, as this increases the likelihood of exacerbation of hyperglycemia. Carvedilol is also known to mask the symptoms of hypoglycemia, which can be dangerous if not corrected quickly.

Medications that can have serious negative interactions with carvedilol include:

  • Amifostine and ceritinib (chemotherapy drugs)
  • Apixaban and Betrixaban (anticoagulants)
  • Amiodarone and Bretilium (heart medications)
  • Aspirin and lidocaine (pain relievers)
  • Cabergoline (dopamine promoter)
  • Clonidine (sedative)
  • Colchicine (anti-inflammatory)

There are other drug interactions that you should be aware of, so it is important to consult with your healthcare professional about the medications you are currently taking.

Other beta blockers

Other beta-blockers with effects similar to carvedilol include:

  • Acebutolol
  • Atenolol
  • Bisoprolol
  • Metoprolol
  • Nadolol
  • Nebivolol
  • Propanolol
  • Timolol

Dose

Although the dosage is individually tailored to the patient's medical history, tolerability, and other medical conditions, the FDA has worked with the manufacturer to develop standard dosages for practical guidance. Carvedilol capsules and tablets are available in doses of 3.125 milligrams (mg), 6.25 mg, 12.5 mg, and 25 mg.

The recommended starting dose for patients with congestive heart failure is 3.125 milligrams twice a day for two weeks. This dose can be increased according to the tolerance of the patient. Obese patients can receive a maximum dose of up to 50 mg twice a day.

The starting dose for patients who have recently had a heart attack is 6.25 mg twice a day for 10 days with the dose adjusted according to the patient's tolerance.

The recommended dose for hypertensive patients is 6.25 mg twice daily for seven to 14 days. Adjustments will be made, if necessary, based on the patient's tolerance.

All indicated doses are indicated by the manufacturer of the drug. Be sure to review your prescription and speak with your doctor to make sure you are taking the correct dosage for your situation.

How to take and store

Talk to your doctor about whether you should take carvedilol with food. Your healthcare professional may recommend taking carvedilol with food to reduce its effects in congestive heart failure. Carvedilol should be taken with enough water to swallow the capsule or tablet.

If you miss a dose, it is recommended that you take the missed dose immediately after you were supposed to take it. However, if you missed a dose and it is time for your next dose, skip the missed dose and continue your normal dosing schedule.

When taking double doses, the patient may feel dizzy or faint and should contact their healthcare professional immediately.

Carvedilol should be stored below 30 ° C in an airtight, light-resistant container, preferably in a cool, dark place.

The capsules contain the powdered medicine inside the outer shell. People who have difficulty swallowing the capsule may be instructed by their healthcare professional to open the capsule and sprinkle this powder on food.

Side effects

Like all medicines, carvedilol can cause side effects. Your healthcare provider will tell you what to expect, but always ask questions if you have any.

general

Common side effects of carvedilol include:

  • Chest pain
  • Dizziness
  • Fainting
  • Swelling of the feet
  • Pain
  • Difficulty breathing
  • Slow heartbeat
  • Weight gain

Severe form

Less common side effects include:

  • Weakness or tingling on one side of the body
  • Back or abdominal pain
  • Numbness and tingling in the hands, feet, or lips.
  • Rapid, shallow breathing.
  • Beating in your ears
  • Slow heartbeat and heartbeat
  • Seizures
  • Speak slurred
  • Temporary blindness

These side effects may indicate a more serious problem that must be addressed immediately with emergency treatment and notifying your healthcare professional.

Warnings and interactions

Carvedilol has a black box warning that the FDA is placing on drugs with potentially serious effects.

Do not stop taking this medicine without first talking to your doctor. If you stop taking this medication without your doctor's instructions, it may cause any of the serious side effects listed, including worsening symptoms that improve after taking carvedilol. Your healthcare provider will instruct you on how to adjust the doses as needed and under close supervision.

It is best for people who have used cocaine to avoid using carvedilol because the combination can lead to increased heart rate, high blood pressure, and an increased risk of stroke and heart attack.

Do not take extended-release carvedilol within two hours of drinking alcohol, as this can affect the rate of absorption and increase cardiovascular symptoms.

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