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Related to Coreg: Beta blockers, Coreg CR


(kar-ve-di-lole) ,


(trade name),

Coreg CR

(trade name)


Therapeutic: antihypertensives
Pharmacologic: beta blockers
Pregnancy Category: C


Hypertension.HF (ischemic or cardiomyopathic) with digoxin, diuretics, and ACE inhibitors.Left ventricular dysfunction after myocardial infarction.


Blocks stimulation of beta1(myocardial) and beta2 (pulmonary, vascular, and uterine)-adrenergic receptor sites.
Also has alpha1 blocking activity, which may result in orthostatic hypotension.

Therapeutic effects

Decreased heart rate and BP.
Improved cardiac output, slowing of the progression of HF and decreased risk of death.


Absorption: Well absorbed but rapidly undergoes extensive first-pass hepatic metabolism, resulting in 25–35% bioavailability. Food slows absorption.
Distribution: Unknown.
Protein Binding: 98%.
Metabolism and Excretion: Extensively metabolized (primarily by CYP2D6 and CYP2C9; the CYP2D6 enzyme system exhibits genetic polymorphism); genetic implication ∼7% of population may be poor metabolizers and may have significantly ↑ carvedilol concentrations and an ↑ risk of adverse effects); excreted in feces via bile, <2% excreted unchanged in urine.
Half-life: 7–10 hr.

Time/action profile (cardiovascular effects)

POwithin 1 hr1–2 hr12 hr
PO-CRunknown5 hr24 hr


Contraindicated in: History of serious hypersensitivity reaction (Stevens-Johnson syndrome, angioedema, anaphylaxis);Pulmonary edema;Cardiogenic shock;Bradycardia, heart block or sick sinus syndrome (unless a pacemaker is in place);Uncompensated HF requiring IV inotropic agents (wean before starting carvedilol);Severe hepatic impairment;Asthma or other bronchospastic disorders.
Use Cautiously in: HF (condition may deteriorate during initial therapy);Renal impairment;Hepatic impairment;Diabetes mellitus (may mask signs of hypoglycemia);Thyrotoxicosis (may mask symptoms);Peripheral vascular disease;History of severe allergic reactions (intensity of reactions may be increased); Obstetric: Crosses placenta and may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression); Lactation / Pediatric: Safety not established; Geriatric: ↑ sensitivity to beta blockers; initial dose reduction recommended.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness (most frequent)
  • fatigue (most frequent)
  • weakness (most frequent)
  • anxiety
  • depression
  • drowsiness
  • insomnia
  • memory loss
  • mental status changes
  • nervousness
  • nightmares

Ear, Eye, Nose, Throat

  • blurred vision
  • dry eyes
  • intraoperative floppy iris syndrome
  • nasal stuffiness


  • bronchospasm
  • wheezing


  • bradycardia (life-threatening)
  • HF (life-threatening)
  • pulmonary edema (life-threatening)


  • diarrhea (most frequent)
  • constipation
  • nausea


  • erectile dysfunction (most frequent)
  • ↓ libido


  • stevens-johnson syndrome (life-threatening)
  • toxic epidermal necrolysis (life-threatening)
  • itching
  • rashes
  • urticaria


  • hyperglycemia (most frequent)
  • hypoglycemia


  • arthralgia
  • back pain
  • muscle cramps


  • paresthesia


  • anaphylaxis (life-threatening)
  • angioedema (life-threatening)
  • drug-induced lupus syndrome


Drug-Drug interaction

General anesthetics, IV phenytoin, diltiazem, and verapamil may cause ↑ myocardial depression.↑ risk of bradycardia with digoxin.Amiodarone or fluconazole may ↑ levels.↑ hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates.Concurrent use with clonidine ↑ hypotension and bradycardia.May ↑ withdrawal phenomenon from clonidine (discontinue carvedilol first).Concurrent administration of thyroid preparations may ↓ effectiveness.May alter the effectiveness of insulins or oral hypoglycemic agents (dose adjustments may be necessary).May ↓ effectiveness of theophylline.May ↓ beneficial beta1-cardiovascular effects of dopamine or dobutamine.Use cautiously within 14 days of MAO inhibitor therapy (may result in hypotension/bradycardia).Cimetidine may ↑ toxicity from carvedilol.Concurrent NSAIDs may ↓ antihypertensive action.Effectiveness may be ↓ by rifampin.May ↑ serum digoxin levels.May ↑ blood levels of cyclosporine (monitor blood levels).


Oral (Adults) Hypertension—6.25 mg twice daily, may be ↑ q 7–14 days up to 25 mg twice daily or extended-release—20 mg once daily, dose may be doubled every 7–14 days up to 80 mg once daily; HF—3.125 mg twice daily for 2 wk; may be ↑ to 6.25 mg twice daily. Dose may be doubled q 2 wk as tolerated (not to exceed 25 mg twice daily in patients <85 kg or 50 mg twice daily in patients >85 kg) or extended-release—10 mg once daily, dose may be doubled every 2 wk as tolerated up to 80 mg once daily; Left ventricular dysfunction after MI—6.25 mg twice daily, ↑ after 3–10 days to 12.5 twice daily then to target dose of 25 mg twice daily; some patients may require lower initial doses and slower titration or extended-release—20 mg once daily, dose may be doubled every 3–10 days up to 80 mg once daily.

Availability (generic available)

Tablets: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg Cost: Generic — All strengths $7.18 / 100
Extended-release capsules: 10 mg, 20 mg, 40 mg, 80 mg Cost: all strengths $175.36 / 30

Nursing implications

Nursing assessment

  • Monitor BP and pulse frequently during dose adjustment period and periodically during therapy. Assess for orthostatic hypotension when assisting patient up from supine position.
  • Monitor intake and output ratios and daily weight. Assess patient routinely for evidence of fluid overload (peripheral edema, dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention). Patients may experience worsening of symptoms during initiation of therapy for HF.
  • Hypertension: Check frequency of refills to determine adherence.
  • Lab Test Considerations: May cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
    • May cause ↑ ANA titers.
    • May cause ↑ in blood glucose levels.
  • Monitor patients receiving beta blockers for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures). Notify health care professional immediately if these signs occur.

Potential Nursing Diagnoses

Decreased cardiac output (Side Effects)
Noncompliance (Patient/Family Teaching)


  • Do not confuse carvedilol with captopril.
    • Discontinuation of concurrent clonidine should be gradual, with carvedilol discontinued first over 1–2 wk with limitation of physical activity; then, after several days, discontinue clonidine.
  • Oral: Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify health care professional.
    • Administer with food to minimize orthostatic hypotension.
    • Administer extended-release capsulesin the morning. Swallow whole; do not crush, break, or chew. Extended-release capsules may be opened and sprinkled on cold applesauce and taken immediately; do not store mixture.
    • To convert from immediate-release to extended-release product, doses of 3.125 mg twice daily can be converted to 10 mg daily; doses of 6.25 mg twice daily can be converted to 20 mg daily; doses of 12.5 mg twice daily can be converted to 40 mg daily; and doses of 25 mg twice daily can be converted to 80 mg daily.

Patient/Family Teaching

  • Instruct patient to take medication as directed, at the same time each day, even if feeling well. Do not skip or double up on missed doses. Take missed doses as soon as possible up to 4 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia.
  • Advise patient to make sure enough medication is available for weekends, holidays, and vacations. A written prescription may be kept in wallet in case of emergency.
  • Teach patient and family how to check pulse and BP. Instruct them to check pulse daily and BP biweekly. Advise patient to hold dose and contact health care professional if pulse is <50 bpm or BP changes significantly.
  • May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
  • Advise patient to change positions slowly to minimize orthostatic hypotension, especially during initiation of therapy or when dose is increased.
  • Caution patient that this medication may increase sensitivity to cold.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products, especially cold preparations, concurrently with this medication.
  • Patients with diabetes should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication may mask some signs of hypoglycemia, but dizziness and sweating may still occur.
  • Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
  • Instruct patient to inform health care professional of medication regimen before treatment or surgery.
  • Advise patient to carry identification describing disease process and medication regimen at all times.
  • Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension.

Evaluation/Desired Outcomes

  • Decrease in BP without appearance of detrimental side effects.
  • Decrease in severity of HF.


A trademark for the drug carvedilol.
References in periodicals archive ?
Impax Laboratories Inc (NASDAQ:IPXL) reported on Friday the receipt of US Food and Drug Administration (FDA) tentative approval for its Abbreviated New Drug Application (ANDA) for the generic version of Coreg CR (carvedilol phosphate) extended-release capsules in 10, 20, 40 and 80 mg.
COREG CR will utilize Flamel's proprietary Micropump[R] technology, which controls the delivery of carvedilol helping to maintain appropriate amounts of medicine in the body over a 24-hour span.
The drug is a generic version of GSK's (NYSE: GSK) Coreg CR.
Bestsellers such as Coreg for high blood pressure and antidepressant Wellbutrin faced pressure from generic versions in the quarter, the final three-month period before Chief Executive Officer Jean-Pierre Garnier retires next month.
Despite this, however, Deutsche Bank said that the patent on Coreg CR, the once-a-day drug for the treatment of three key cardiovascular conditions, is likely to be protected from generic competition until 2023.
In 2007, seven popular products--Norvasc (amlodipine besylate), Ambien (zoldipem tartrate), Zyrtec (cetirizine), Lotrel (amlodipine/benazepril), Coreg (carvedilol), Lamisil (terbinafine), and Tequin (gatifloxicin), are due to lose patent protection, noted PCMA, which could lead to $700 million in savings that year.
Since making changes in my diet, adding regular exercise, and taking a medication called Coreg, my ejection fraction has been as high as 59 percent, which is outstanding.
The scheduled patent expiries of Cozaar (US and Europe), Aceon (US), Coreg (US) and Diovan (Europe) are expected to have a minimal impact on the PKD therapeutics market as the annual cost of therapy associated with these drugs is significantly low.
Earlier in his career, Derkacz has worked for more than 15 years at GlaxoSmithKline for major brands including Levitra, Paxil, Coreg and its adult vaccine portfolio.
Medco managers credited the early release of some generic medications, including versions of the popular high blood-pressure treatments Toprol XL and Coreg, as well as strong mail-order volume.
Although sales of asthma drug Advair and diabetes drug Avandia are likely to have disappointed over the final quarter, GSK is expected to have benefited from a good performance in its vaccine business as well as heart drug Coreg.
3 MM payment resulting from a multi-year supply agreement signed with GSK for the production of Coreg CR[R] microparticles.