carvedilol


Also found in: Dictionary, Thesaurus, Wikipedia.
Related to carvedilol: Ramipril

carvedilol

 [kahr´vĕ-dil″ol]
a beta-adrenergic blocking agent used in treatment of hypertension and as an adjunct in treatment of congestive heart failure; administered orally.

carvedilol

Apo-Carvedilol (CA), Coreg, Dom-Carvedilol (CA), Eucardic (UK)

carvedilol phosphate

Coreg CR, Novo-Carvedilol (CA), PHL-Carvedilol (CA), PMS-Carvedilol (CA)

Pharmacologic class: Beta-adrenergic blocker (nonselective)

Therapeutic class: Antihypertensive

Pregnancy risk category C

Action

Blocks stimulation of cardiac beta1-adrenergic receptor sites and pulmonary beta2-adrenergic receptor sites. Shows intrinsic sympathomimetic activity, causing slowing of heart rate, decreased myocardial excitability, reduced cardiac output, and decreased renin release from kidney.

Availability

Capsules (extended-release): 10 mg, 20 mg, 40 mg, 80 mg

Tablets: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg

Indications and dosages

Hypertension

Adults: Initially, 6.25 mg P.O. b.i.d. (Coreg). May be increased q 7 to 14 days to a maximum dosage of 25 mg b.i.d. Or, 20 mg P.O. daily (Coreg CR). If tolerated, using standing systolic pressure about 1 hour after dosing, maintain dosage of Coreg CR for 7 to 14 days; then increase to 40 mg once daily if needed based on trough systolic standing blood pressure. Maintain this dosage for 7 to 14 days and adjust to 80 mg once daily if tolerated and needed. Total daily dose of Coreg CR shouldn't exceed 80 mg.

Heart failure caused by ischemia or cardiomyopathy

Adults: Initially, 3.125 mg P.O. b.i.d. (Coreg) for 2 weeks. May increase to 6.25 mg b.i.d. Dosage may be doubled q 2 weeks as tolerated, not to exceed 25 mg b.i.d. in patients weighing less than 85 kg (187 lb) or 50 mg b.i.d. in patients weighing more than 85 kg. Or, 10 mg P.O. daily (Coreg CR) for 2 weeks. If tolerated, increase dosage to 20 mg, 40 mg, and 80 mg over successive intervals of at least 2 weeks.

Left ventricular dysfunction following myocardial infarction

Adults: Initially, 6.25 mg P.O. b.i.d. (Coreg); increase after 3 to 10 days to 12.5 mg b.i.d. (based on tolerability), then increase to target dosage of 25 mg b.i.d. A lower starting dose (3.125 mg b.i.d.) or slower titration may be used if clinically indicated. Or, 20 mg P.O. once daily (Coreg CR); increase after 3 to 10 days to 40 mg daily (based on tolerability), then increase to target dose of 80 mg daily. A lower starting dose may be used (10 mg daily) or the rate of up titration may be slowed if clinically indicated.

Off-label uses

• Angina pectoris

• Idiopathic cardiomyopathy

Contraindications

• Hypersensitivity to drug

• Uncompensated heart failure

• Pulmonary edema

• Cardiogenic shock

• Bradycardia or heart block

• Severe hepatic impairment

• Bronchial asthma, bronchospasm

Precautions

Use cautiously in:

• renal or hepatic impairment, pulmonary disease, diabetes mellitus, hypoglycemia, thyrotoxicosis, peripheral vascular disease, hypotension, respiratory depression

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

• Ensure that patient is hemodynamically stable and fluid retention has been minimized before starting therapy.

• Give immediate-release form with food to slow absorption and minimize orthostatic hypotension.

• Give extended-release form in the morning with food and instruct patient to swallow capsule whole.

• For patients who can't swallow capsules whole, carefully open capsules and sprinkle contents on applesauce; have patient swallow contents immediately without chewing. Don't use warm applesauce; doing so could affect the modified-release properties of this formulation.

• When drug is used to treat heart failure, check apical pulse before administering. If it's below 60 beats/minute, withhold dosage and contact prescriber.

• When drug is used for hypertension, check standing systolic pressure about 1 hour after dosing for use as a guide for patient tolerance.

• Be aware that addition of diuretic may cause additive effects and may worsen orthostatic hypotension.

• Know that full antihypertensive effect takes 7 to 14 days.

Don't withdraw drug abruptly, because this may lead to withdrawal phenomenon (angina exacerbation, myocardial infarction, ventricular arrhythmias, and even death).

Adverse reactions

CNS: dizziness, fatigue, anxiety, depression, insomnia, memory loss, nightmares, headache, pain

CV: orthostatic hypotension, peripheral vasoconstriction, angina pectoris, chest pain, hypertension, bradycardia, heart failure, atrioventricular block

EENT: blurred or abnormal vision, dry eyes, stuffy nose, rhinitis, sinusitis, pharyngitis

GI: nausea, diarrhea, constipation

GU: urinary tract infection, hematuria, albuminuria, decreased libido, erectile dysfunction, renal dysfunction

Hematologic: bleeding, purpura, thrombocytopenia

Metabolic: hypovolemia, hypervolemia, hyperglycemia, hyponatremia, hyperuricemia, glycosuria, gout, hypoglycemia

Musculoskeletal: arthralgia, back pain, muscle cramps

Respiratory: wheezing, upper respiratory tract infection, dyspnea, bronchitis, bronchospasm, pulmonary edema

Skin: pruritus, rash

Other: weight gain, lupuslike syndrome, viral infection, anaphylaxis

Interactions

Drug-drug. Antihypertensives: additive hypotension

Calcium channel blockers, general anesthetics, I.V. phenytoin: additive myocardial depression

Cimetidine: increased carvedilol toxicity

Clonidine: increased hypotension and bradycardia, exaggerated withdrawal phenomenon

Digoxin: additive bradycardia

Dobutamine, dopamine: decrease in beneficial cardiovascular effects

Insulin, oral hypoglycemics: altered efficacy of these drugs

MAO inhibitors: hypertension

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive action

Rifampin, thyroid preparations: decreased carvedilol efficacy

Theophyllines: reduced theophylline elimination, antagonistic effect that decreases theophylline or carteolol efficacy

Drug-diagnostic tests. Antinuclear antibodies: increased titers

Blood urea nitrogen, glucose, lipoproteins, potassium, triglycerides, uric acid: increased levels

Drug-food. Any food: delayed drug absorption

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Watch for signs and symptoms of hypersensitivity reaction.

• Assess baseline CBC and kidney and liver function test results.

• Monitor vital signs (especially blood pressure), ECG, and exercise tolerance. Drug may alter cardiac output and cause ineffective airway clearance.

• Weigh patient daily and measure fluid intake and output to detect fluid retention.

• Measure blood glucose regularly if patient has diabetes mellitus. Drug may mask signs and symptoms of hypoglycemia.

Patient teaching

• Instruct patient to take drug with food exactly as prescribed.

• Tell patient to take extended-release capsule in the morning with food, to swallow capsule whole, and not to chew, crush, or divide its contents.

• Instruct patient who can't swallow capsule whole to carefully open capsule, sprinkle contents on cool or cold applesauce, and swallow contents immediately without chewing. Tell patient not to store mixture for future use.

Caution patient not to stop taking drug abruptly, because serious reactions may result.

• Advise patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from sudden blood pressure drop.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Inform male patient that drug may cause erectile dysfunction. Advise him to discuss this issue with prescriber.

• Advise patient to use soft-bristled toothbrush and electric razor to avoid gum and skin injury.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and behaviors mentioned above.

car·ve·di·lol

(kar-vē'dil-ol),
An antihypertensive and antianginal agent, also used in congestive heart failure.

carvedilol

/car·ve·dil·ol/ (kahr´vĕ-dil″ol) a beta-adrenergic blocking agent used in the treatment of hypertension and as an adjunct in the treatment of congestive heart failure.

carvedilol

(kär-vā′dĭ-lôl′, -lōl′ -vĕd′ĭ-)
n.
A beta-blocker drug, C24H26N2O4, used especially to treat congestive heart failure and hypertension.

carvedilol

an alpha-/beta-adrenergic blocker.
indications It is used to treat congestive heart failure and essential hypertension, either alone or in combination with other antihypertensives.
contraindications Known hypersensitivity to this drug, bronchial asthma, class IV decompensated cardiac failure, second- or third-degree heart block, cardiogenic shock, or severe bradycardia and pulmonary edema prohibits the use of carvedilol.
adverse effects Life-threatening effects of this drug include atrioventricular block, bradycardia, congestive heart failure, pulmonary edema, and thrombocytopenia. Other serious adverse effects include somnolence, depression, ataxia, diarrhea, dependent edema, peripheral edema, extrasystoles, hypertension, hypotension, palpitations, peripheral ischemia, urinary tract infection, viral infection, and hypertriglyceridemia.

carvedilol

A drug used in the treatment of HEART FAILURE and ANGINA PECTORIS. A brand name is Eucardic.

carvedilol (kär´vədil´ol),

n brand name: Coreg;
drug class: nonselective β-adrenergic blocking agent with α-blocking activity;
action: produces fall in blood pressure without reflex tachycardia or significant reduction in heart rate;
use: essential hypertension alone or with other antihypertensives.

carvedilol

a third generation beta-adrenergic blocker used in the treatment of congestive heart failure.
References in periodicals archive ?
Also, the disease severity stratification used in US Carvedilol is not standardized, and the sample size representing the most severe patients was less than 10% of the study population.
Carvedilol is contraindicated in bronchial asthma patients; two cases of fatal bronchospasm have been reported following single doses.
Even among hypertensive patients who do not have diabetes, carvedilol may be a good option if they have indications of impaired glucose control or if they have inflammatory markers, Dr.
1]-selective agents, carvedilol doesn't worsen blood glucose, said Dr.
carvedilol is sold for the treatment of hypertension under trade names including Dilatrend, Dimitone, and Kredex.
Other [beta]-blockers increase insulin resistance; carvedilol (Coreg), a nonselective [beta]blocker, reduces it.
Of the three beta-blockers used in heart failure, carvedilol alone may make blood sugar somewhat harder to control.
Carvedilol's cancer-fighting properties were discovered when a former graduate student in Huang's lab was studying whether carvedilol and similar beta blockers might increase cancer risk, Medical Xpress reported.
They also compared atenolol, bisoprolol, bucindolol, carvedilol, metoprolol, and nebivolol with each other and found no significant difference in risk of death, sudden cardiac death, death resulting from pump failure, or tolerability.
One such medicine was Carvedilol, now under clinical investigation in Alzheimer 's disease with the intent to slow down memory deterioration.
and his colleagues conducted a systematic review and meta-analysis comparing outcomes between clinical trial subjects with systolic HF or AMI receiving carvedilol and those receiving [beta.
The researchers remind us that in addition to being a beta-nonselective BB and an alpha, blocker, carvedilol may have unique vasodilating, antioxidant, and antiarrhythmic effects.