(kar vah' da lol)
Pregnancy Category C
Alpha- and beta-adrenergic blocker
Competitively blocks alpha-, beta-, and beta2-adrenergic receptors and has some sympathomimetic activity at beta2-receptors. Both alpha and beta blocking actions contribute to the BP-lowering effect; beta blockade prevents the reflex tachycardia seen with most alpha-blocking drugs and decreases plasma renin activity. Significantly reduces plasma renin activity.
· Hypertension, alone or with other oral drugs, especially diuretics
· Treatment of mild to severe CHF of ischemic or cardiomyopathic origin with digitalis, diuretics, ACE inhibitors
· Left ventricular dysfunction (LVD) after MI
· Unlabeled uses: Angina (25–50 mg bid)
Contraindications and cautions
· Contraindicated with decompensated CHF, bronchial asthma, heart block, cardiogenic shock, hypersensitivity to carvedilol, pregnancy, lactation.
· Use cautiously with hepatic impairment, peripheral vascular disease, thyrotoxicosis, diabetes, anesthesia, major surgery.
Tablets—3.125, 6.25, 12.5, 25 mg
· Hypertension: 6.25 mg PO bid; maintain for 7–14 days, then increase to 12.5 mg PO bid if needed to control BP. Do not exceed 50 mg/day.
· CHF: Monitor patient very closely, individualize dose based on patient response. Initial dose, 3.125 mg PO bid for 2 wk, may then be increased to 6.25 mg PO bid. Maximum dose, 25 mg PO bid in patients < 85 kg or 50 mg PO bid in patients > 85 kg.
Safety and efficacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
Do not administer to any patient with severe hepatic impairment.
Metabolism: Hepatic; T1/2: 7–10 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Bile, feces
· CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances
· CV: Bradycardia, orthostatic hypertension, CHF, cardiac arrhythmias, pulmonary edema, hypotension
· GI: Gastric pain, flatulence, constipation, diarrhea, hepatic failure
· Respiratory: Rhinitis, pharyngitis, dyspnea
· Other: Fatigue, back pain, infections
· Increased effectiveness of antidiabetics; monitor blood glucose and adjust dosages appropriately
· Increased effectiveness of clonidine; monitor patient for potential severe bradycardia and hypotension
· Increased serum levels of digoxin; monitor serum levels and adjust dose accordingly
· Increased plasma levels of carvedilol with rifampin
· Potential for dangerous conduction system disturbances with verapamil or diltiazem; if this combination is used, closely monitor ECG and BP
· Slowed rate of absorption but not decreased effectiveness with food
· History: CHF, bronchial asthma, heart block, cardiogenic shock, hypersensitivity to carvedilol, pregnancy, lactation, hepatic impairment, peripheral vascular disease, thyrotoxicosis, diabetes, anesthesia or major surgery
· Physical: Baseline weight, skin condition, neurologic status, P, BP, ECG, respiratory status, kidney and thyroid function, blood and urine glucose, liver function tests
· WARNING: Do not discontinue drug abruptly after chronic therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias); taper drug gradually over 2 wk with monitoring.
· Consult with physician about withdrawing drug if patient is to undergo surgery (withdrawal is controversial).
· Give with food to decrease orthostatic hypotension and adverse effects.
· Monitor for orthostatic hypotension and provide safety precautions.
· Monitor patients with diabetes closely; drug may mask hypoglycemia or worsen hyperglycemia.
· WARNING: Monitor patient for any sign of liver dysfunction (pruritus, dark urine or stools, anorexia, jaundice, pain); arrange for liver function tests and discontinue drug if tests indicate liver injury. Do not restart carvedilol.
· Take drug with meals.
· Do not stop taking drug unless instructed to do so by a health care provider.
· Avoid use of OTC medications.
· You may experience these side effects: Depression, dizziness, light-headedness (avoid driving or performing dangerous activities; getting up and changing positions slowly may help ease dizziness).
· Report difficulty breathing, swelling of extremities, changes in color of stool or urine, very slow heart rate, continued dizziness.
Adverse effects in Italic are most common; those in Bold are life-threatening.