Carvedilol

Generic Name: carvedilol (KAR ve dil ole)
Brand Name: Coreg, Coreg CR

What is carvedilol?

Carvedilol (Coreg) belongs to a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

Carvedilol is used to treat heart failure and hypertension (high blood pressure). It is also used after a heart attack that has caused your heart not to pump as well.

Carvedilol may also be used for purposes not listed in this medication guide.

Important information about carvedilol

You should not take this medication if you are allergic to carvedilol, or if you have asthma, bronchitis, emphysema, severe liver disease, or a serious heart condition such as heart block, sick sinus syndrome, or slow heart rate (unless you have a pacemaker).

If you need surgery, tell the surgeon ahead of time that you are using carvedilol. You may need to stop using the medicine for a short time.

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Do not stop taking carvedilol without first talking to your doctor. Stopping suddenly may make your condition worse.

Avoid drinking alcohol within 2 hours before or after taking extended-release carvedilol (Coreg CR). Also avoid taking medicines or other products that might contain alcohol. Alcohol may cause the carvedilol in Coreg CR to be released too quickly into the body.

If you are being treated for high blood pressure, keep using carvedilol even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Before taking carvedilol

You should not take this medication if you are allergic to carvedilol, or if you have:

• asthma, bronchitis, emphysema;

• severe liver disease; or

• a serious heart condition such as heart block, sick sinus syndrome, or slow heart rate (unless you have a pacemaker).

To make sure you can safely take carvedilol, tell your doctor if you have any of these other conditions:

• diabetes (taking carvedilol can make it harder for you to tell when you have low blood sugar);

• angina (chest pain);

• low blood pressure;

• kidney disease;

• liver disease;

• a thyroid disorder;

• pheochromocytoma (tumor of the adrenal gland);

• circulation problems (such as Raynaud's syndrome); or

• a history of allergies.

FDA pregnancy category C. It is not known whether carvedilol will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

See also: Carvedilol pregnancy and breastfeeding warnings (in more detail)

It is not known whether carvedilol passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are taking carvedilol.

How should I take carvedilol?

Take carvedilol exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

Carvedilol works best if you take it with food.

Take carvedilol at the same time every day. Do not skip doses or stop taking carvedilol without first talking to your doctor. Stopping suddenly may make your condition worse.

You may open the carvedilol capsule and sprinkle the medicine into a spoonful of pudding or applesauce to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

If you are switched from carvedilol tablets to carvedilol extended-release capsules (Coreg CR), your daily total dose of this medicine may be higher or lower than before. Older adults may be more likely to become dizzy or feel faint when switching from tablets to extended-release capsules. Follow your doctor's instructions.

If you are being treated for high blood pressure, keep using carvedilol even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Your blood pressure will need to be checked often. Visit your doctor regularly.

If you need surgery, tell the surgeon ahead of time that you are using carvedilol. You may need to stop using the medicine for a short time.

Carvedilol can affect your pupils during cataract surgery. Tell your eye surgeon ahead of time that you are using this medication. Do not stop using carvedilol before surgery unless your surgeon tells you to.

Carvedilol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

Store carvedilol at room temperature away from moisture and heat.

See also: Carvedilol dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include uneven heartbeats, shortness of breath, bluish-colored fingernails, dizziness, weakness, fainting, and seizure (convulsions).

What should I avoid while taking carvedilol?

Carvedilol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid drinking alcohol within 2 hours before or after taking extended-release carvedilol (Coreg CR). Also avoid taking medicines or other products that might contain alcohol. Alcohol may cause the carvedilol in Coreg CR to be released too quickly into the body. Check the labels of any prescription or over-the-counter medicines you take to see if they contain alcohol (also called ethanol).

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Carvedilol side effects

Get emergency medical help if you have any of these signs of an allergic reaction to carvedilol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• feeling like you might pass out;

• slow or uneven heartbeats;

• chest pain, dry cough, wheezing, chest tightness, trouble breathing;

• feeling short of breath, even with mild exertion;

• swelling, rapid weight gain;

• numbness or cold feeling in your hands and feet;

• loss of bladder control;

• pale skin, feeling light-headed, rapid heart rate, trouble concentrating;

• high blood sugar (increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss); or

• severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious carvedilol side effects may include:

• dizziness, drowsiness;

• nausea, vomiting, diarrhea;

• dry eyes;

• feeling weak or tired;

• joint pain;

• cough; or

• decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Carvedilol side effects (in more detail)

Carvedilol Dosing Information

Usual Adult Dose of Carvedilol for Angina Pectoris:

Immediate-release tablets:
Initial dose: 6.25 mg orally twice a day with food
Maintenance dose: 6.25 mg to 25 mg orally twice a day with food
Maximum dose: 50 mg per day

Usual Adult Dose of Carvedilol for Congestive Heart Failure:

Immediate-release tablets:
Initial dose: 3.125 mg orally twice a day for 2 weeks. If tolerated, increase dosage to 6.25 mg orally twice a day.

Dosage should then be doubled every 2 weeks to the highest level tolerated by the patient.

Maximum dose: 50 mg orally twice a day in patients weighing 85 kg or greater and 25 mg orally twice a day in patients weighing 85 kg or less

Extended-release capsules:
Initial dose: 10 mg orally once a day for 2 weeks. If tolerated, increase dosage to 20 mg, 40 mg, and 80 mg over successive intervals of at least 2 weeks.

Usual Adult Dose of Carvedilol for Hypertension:

Immediate-release tablets:
Initial dose: 6.25 mg orally twice a day with food
Maintenance dose: 6.25 mg to 25 mg orally twice a day with food
Maximum dose: 50 mg per day

Extended-release capsules:
Initial dose: 20 mg orally once a day for 7 to 14 days. If tolerated, may increase dosage to 40 mg orally once a day, then again to 80 mg orally once a day after 7 to 14 days.

Maximum dose: 80 mg per day

Usual Adult Dose of Carvedilol for Left Ventricular Dysfunction:

Immediate-release tablets:
Initial dose: 6.25 mg orally twice a day (an initial dosage of 3.25 mg twice daily can be given to patients unable to tolerate the initial dosage).

Maintenance dose: If tolerated, the initial dosage may be titrated to 12.5 mg twice a day after 3 to 10 days to a target dose of 25 mg twice a day.

Extended-release capsules:
Initial dose: 20 mg orally once a day (an initial dosage of 10 mg once daily can be given to patients unable to tolerate the initial dosage). If tolerated, may increase dosage to 40 mg after 3 to 10 days, then again to 80 mg orally once a day.

What other drugs will affect carvedilol?

Many drugs can interact with carvedilol. Below is just a partial list. Tell your doctor if you are using:

• allergy treatments (or if you are undergoing allergy skin-testing);

• cimetidine (Tagamet);

• cyclosporine (Gengraf, Neoral, Sandimmune);

• fluconazole (Diflucan);

• insulin or oral diabetes medication;

• rifampin (Rifadin, Rifater, Rifamate);

• an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), bupropion (Wellbutrin, Zyban), clomipramine (Anafranil), desipramine (Norpramin), duloxetine (Cymbalta), fluoxetine (Prozac, Sarafem), imipramine (Tofranil), paroxetine (Paxil), or sertraline (Zoloft);

• heart or blood pressure medicine such as amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta), clonidine (Catapres), diltiazem (Cartia, Cardizem), nifedipine (Nifedical, Procardia), reserpine, verapamil (Calan, Covera, Isoptin, Verelan), and others;

• a heart rhythm medication such as amiodarone (Cordarone, Pacerone), digoxin (digitalis, Lanoxin), flecainide (Tambocor), propafenone (Rythmol), or quinidine (Quin-G);

• HIV or AIDS medicine such as delavirdine (Rescriptor) or ritonavir (Norvir, Kaletra);

• an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate);

• medicine to prevent or treat nausea and vomiting, such as metoclopramide (Reglan) or promethazine (Pentazine, Phenergan, Anergan, Antinaus);

• medicine to treat psychiatric disorders, such as aripiprazole (Abilify), chlorpromazine (Thorazine), fluphenazine (Permitil, Prolixin), haloperidol (Haldol), perphenazine (Trilafon), or thioridazine (Mellaril); or

• a narcotic such as methadone (Methadose, Diskets, Dolophine) or propoxyphene (Daron, Darvocet).

This list is not complete and there are many other drugs that can interact with carvedilol. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Where can I get more information?

• Your pharmacist can provide more information about carvedilol.