Carvedilol

Carvedilol is a beta blocker medicine used to treat high blood pressure (hypertension) and helps prevent heart disease, heart attacks, and strokes[1]. It can also be given with other medicines to treat heart failure and to prevent chest pain caused by angina.[1]

Carvedilol
Clinical data
Trade namesCoreg, others
SynonymsBM-14190
AHFS/Drugs.comMonograph
MedlinePlusa697042
License data
Routes of
administration		By mouth
ATC code
Pharmacokinetic data
Bioavailability25–35%
Protein binding98%
MetabolismLiver (CYP2D6, CYP2C9)
Elimination half-life7–10 hours
ExcretionUrine (16%), feces (60%)
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
PDB ligand
ECHA InfoCard100.117.236
Chemical and physical data
ChiralityRacemic mixture
  (verify)

It makes it easier for the heart to pump blood around the body. Usually, carvedilol will need to be taken once or twice a day.[1] It usually starts to work after about 1 hour. But it will take days or weeks for it to reach its full effect.[1]

This medicine can cause serious allergic reactions that require emergency treatment. Make sure the signs of these reactions are known: read allergic reaction symptoms of drugs.

Pregnancy category: US:[2] not assigned or (COREG):[3] C, AU:[4] C, UK:[1] 'Carvedilol is not usually recommended if you're pregnant.'.

Carvedilol was patented in 1978 and approved for medical use in the United States in 1995.[5][6] It is on the World Health Organization's List of Essential Medicines.[7] It is available as a generic medication.[5] In 2021, it was the 26th most commonly prescribed medication in the United States, with more than 21 million prescriptions.[8][9][10]

How and when to take carvedilol

When first starting taking carvedilol, the doctor may advise that the first dose is taken just before bed. This is because it can make people feel dizzy. After the first dose, if it does not cause the dizzy feeling, then it can taken in the morning. If it does cause the person to feel dizzy, it’s best to keep taking the medicine at bedtime.[1] It’s best to take carvedilol at the same time each day. If taking it twice a day, then, usually, 1 dose will be taken in the morning and 1 dose in the evening. Leave 10 to 12 hours between doses if possible.[1]

Carvedilol does not usually cause stomach upset, so it can be taken with or without food. However, if carvedilol is being taken for heart failure, it’s best to take the tablets with food. This will help reduce the risk of it causing the faint or dizzy feelings when standing up.[1] The tablets should be swallowed whole with a drink of water. Do not chew or crush them. If tablets are difficult to swallow, some strengths have a score line to help people break the tablet in half. Check the information leaflet that comes with the medicine to see if this is possible.[1]

If a dose of carvedilol is missed, it should be taken as soon as it is remembered, unless it’s nearly time for the next dose. In this case, just leave out the missed dose and take the next dose as normal.[1] Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.[1]

Do not stop taking carvedilol suddenly. This can make a condition worse, especially in people with heart disease.[1]

If often forgetting doses, it may help to set an alarm as a reminder. A pharmacist can be asked for advice on other ways to help with remembering to take medicines.[1]

Taking too much (overdose)

The amount of carvedilol that can lead to an overdose varies from person to person. But taking too much can lower blood pressure, slow heart rate, and make it difficult to breathe.[1]

Dosage

Carvedilol tablets come in 4 different strengths. There are 3.125mg, 6.25mg, 12.5mg and 25mg tablets. The dose depends on why carvedilol is needed.[1]

The usual starting dose to treat:

  • high blood pressure[1]

12.5mg once a day for 2 days – this is increased to 25mg, taken once a day. If blood pressure does not go down enough then the doctor may increase the dose to up to 50mg a day. This can be taken as a single dose or split into 2 doses.

  • heart failure[1]

3.125mg taken twice a day for 2 weeks. The doctor will then slowly increase the dose every 2 weeks up to a maximum of 25mg to 50mg (depending on weight).

12.5mg, taken twice a day for 2 days – this is increased to 25mg, taken twice a day.

If a child is being prescribed carvedilol, the doctor will use their weight to work out the right dose.[1]

See the section on how and when to take carvedilol for more information about dose.

Side effects

Like all medicines, carvedilol can cause side effects in some people, but many people have no side effects or only minor ones. Side effects usually improve as the body gets used to the medicine.[1]

Common side effects

These common side effects may happen in more than 1 in 100 people. They’re usually mild and last a few days after starting the medicine or increasing the dose.[1] Talk to a doctor or pharmacist if these side effects are a bother or do not go away:[1]

Serious side effects

It happens rarely, but some people have serious side effects when taking carvedilol.[1] Tell a doctor straight away if there is:[1]

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to carvedilol.[1]

Conflicts

Carvedilol can be taken by most adults.[1] It can sometimes be prescribed by a specialist for children aged 2 years and over.[1] However, Carvedilol is not suitable for some people[1]. It should be reported to the doctor before starting the medicine if:

Caution (conflicts with other medicine)

There are some medicines that can affect the way carvedilol works. Tell a doctor if any of these medicines are being taken:[1]

  • other medicines for high blood pressure – when taken together with carvedilol, they can sometimes lower blood pressure too much
  • other medicines that can lower blood pressure – these include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or levodopa (for Parkinson’s disease)
  • medicines for an irregular heartbeat such as amiodarone or flecainide
  • medicines for asthma or chronic obstructive pulmonary disease (COPD)
  • medicines for diabetes, particularly insulin – carvedilol may make it more difficult to recognise the warning signs of low blood sugar. Speak to a doctor if there are sometimes low blood sugar levels without getting any warning signs. Check blood sugar after exercise, and follow usual advice about checking it before driving, or operating machinery.
  • medicines that treat nose or sinus congestion, or other cold remedies (including those which can be purchased in the pharmacy)
  • medicines for allergies, such as ephedrine, noradrenaline or adrenaline
  • non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, diclofenac and naproxen – these medicines may increase blood pressure

Mixing carvedilol with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements with carvedilol. However, some herbal products, such as cod liver oil, hawthorn and garlic tablets may cause low blood pressure (hypotension).

References
  1. "Carvedilol: a medicine used to treat high blood pressure and prevent angina, heart disease and stroke". nhs.uk. 2021-03-11. Retrieved 2024-06-02.
  2. "Carvedilol Use During Pregnancy". Drugs.com. Retrieved 2024-06-03.
  3. "(Carvedilol) tablets" (PDF).
  4. "Carvedilol Use During Pregnancy". Drugs.com. Retrieved 2024-06-03.
  6. Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 463. ISBN 9783527607495.
  7. World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl:10665/345533. WHO/MHP/HPS/EML/2021.02.
  8. "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
  9. "Carvedilol - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
  10. Source Wikipedia
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