Carvedilol is a generic medication for the drug Coreg:
Carvedilol medication comes in several different strengths; click on the strength you need to view prices from pharmacies competing to earn your business.
Carvedilol 3.125 mg
Carvedilol 6.250 mg
Carvedilol 12.500 mg
Carvedilol 25 mg
|Interacting Drug||Effect||Clinical Comment|
|Amiodarone||Amiodarone inhibited the metabolism of carvedilol in heart failure patients [Stereoselective effect of amiodarone on the pharmacokinetics of racemic carvedilol. Drug Metab Pharmacokinet 2005;20(6):423-7]. The S(−) enantiomer of carvedilol was affected to a greater extent than the R(+) enantiomer.||Monitor patients for signs of carvedilol excess if amiodarone is initiated in patients stabilized on carvedilol. Adjust the dose of carvedilol as needed.|
|Cimetidine||The steady-state area under the plasma concentration versus time curve (AUC) of carvedilol increased by 30% when coadministered with cimetidine.||Use an alternative H2-receptor antagonist.|
|Cyclosporine||The trough concentration of cyclosporine increased when carvedilol therapy was initiated in renal transplant recipients.||Monitor patients for signs of cyclosporine excess if carvedilol is initiated in patients stabilized on cyclosporine. Monitor serum concentrations of cyclosporine and adjust the dose of cyclosporine as needed.|
|Digoxin||Carvedilol increases serum digoxin concentrations.||Monitor patients for signs of digoxin excess and measure serum digoxin concentrations if carvedilol is initiated in patients stabilized on digoxin. Adjust the dose of digoxin as needed.|
|Fluoxetine||Fluoxetine selectively inhibited CYP2D6-mediated metabolism and decreased the clearance of carvedilol in heart failure patients who were extensive metabolizers of CYP2D6 substrates [Effect of fluoxetine on carvedilol pharmacokinetics, CYP2D6 activity, and autonomic balance in heart failure patients. J Clin Pharmacol 2001;41(1):97-106]. The R(+) enantiomer was affected to a greater extent than the S(−) enantiomer.||Despite the significant effects of fluoxetine on carvedilol metabolism there was no significant difference in adverse events, blood pressure or heart rate over 4 weeks.|
|Rifampin||The AUC of carvedilol decreased by 70% when coadministered with rifampin.||If a patient on carvedilol must be treated with rifampin, increased dosages of carvedilol may be required. Monitor patients and adjust the dose when introducing and withdrawing rifampin.|
The combination of carvedilol and other drugs with antihypertensive effects may result in an additive or exaggerated hypotensive effect. Concomitant use of carvedilol and drugs that affect cardiac conduction (e.g., diltiazem, verapamil, antiarrhythmic agents) may result in cardiac conduction abnormalities and hemodynamic compromise.
Carvedilol undergoes oxidative metabolism mediated by hepatic cytochrome P450 isozymes, the most important of which is CYP2D6. Thus the pharmacokinetics of the drug may be altered when coadministered with strong inhibitors of CYP2D6.
No pharmacokinetic drug-drug interaction was detected in studies designed to evaluate the potential for drug interactions between carvedilol and glyburide, hydrochlorothiazide, torsemide or warfarin.
Dosage and Administration
Carvedilol should be taken with food to minimize the risk of orthostatic hypotension.
If the patient misses a dose they should be advised to take it as soon as they remember, unless it is time for the next dose. They should be advised to resume their normal schedule without taking 2 doses at the same time.
Carvedilol is not removed by hemodialysis or peritoneal dialysis. Administration of supplemental doses is not recommended after dialysis sessions.
Carvedilol is contraindicated in patients with severe liver dysfunction, but patients with mild liver disease may receive carvedilol. The starting dose does not need to be altered in these patients, but because of the potential for higher plasma levels and an increased likelihood of vasodilation the dosage should be increased more cautiously than in patients without liver dysfunction. The maximum tolerated dose at the end of the dosage titration period may be lower in such patients than in similar individuals without liver dysfunction.
Carvedilol undergoes stereoselective hepatic metabolism mediated by CYP2D6 (see Pharmacokinetics: Adults).
Patients with heart failure should be clinically stable for at least 4 weeks before initiating treatment with carvedilol. This includes being on stable doses of ACE inhibitors (if tolerated) and diuretics with or without digoxin.
In patients with heart failure the initial dose of carvedilol must be low (i.e., 3.125 mg BID) and the dose should be increased slowly to the target dose or the maximum tolerated dose. Abrupt withdrawal or major reductions in the dose of carvedilol should be avoided. If a patient becomes hypotensive, consideration may be given to reducing the dosage of other medications or changing the timing of administration of other medications (i.e., an ACE inhibitor) before reducing the dose of carvedilol.
Objective improvement in cardiac function may not be apparent for 6 to 12 months after initiating treatment with a beta blocker in a patient with heart failure.
If fluid retention and/or worsening heart failure occur after initiation of carvedilol, consider increasing the dose of diuretic and delaying titration of the dose of carvedilol. It may be necessary to reduce the dose of carvedilol or temporarily discontinue the drug in some patients. If the dosage of carvedilol is decreased because of worsening heart failure, the dosage should not be increased until the symptoms have been stabilized for at least 2 weeks.
The dosage of carvedilol should be reduced if the pulse falls below 55 beats per minute. Caution patients who experience dizziness or fatigue to avoid driving or hazardous activities when initiating treatment or increasing the dose. These events are most likely to occur within 2 hours after administration.
convulsions (rare), hypesthesia, hypokinesia, migraine, paresthesia, vertigo.
In patients with mild to moderate heart failure, hypotension or postural hypotension occurred in 9.7% of patients randomized to carvedilol and in 3.6% of those randomized to placebo. In patients with severe heart failure, hypotension or postural hypotension occurred in 15.1% of patients randomized to carvedilol and in 8.7% of those randomized to placebo. Among patients treated with carvedilol in these trials, syncope was reported in 3.4% of patients with mild-to-moderate heart failure (vs 2.5% with placebo), and in 2.9% of those with severe heart failure (vs 2.3% with placebo). In patients with left ventricular dysfunction after myocardial infarction the incidence of hypotension or postural hypotension was 20.2% among those treated with carvedilol (vs 12.6% with placebo). Syncope was reported by 3.9% of carvedilol recipients and 1.9% of placebo recipients in this trial. Bradycardia occurs more often in patients receiving carvedilol for heart failure (9%) or after myocardial infarction (6.5%) than for hypertension (2%). Hypotension occurs most often during the first 30 days of treatment. Patients should be advised to take carvedilol with food to minimize the risk of postural hypotension.
albuminuria, hematuria, increased frequency of micturition, increased serum creatinine, renal insufficiency, urinary incontinence.
blurred vision, tinnitus.