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Why it's used

Carvedilol is a prescription medicine that is used to treat mild to severe long-term heart failure, heart disease following a heart attack and high blood pressure. Carvedilol works by slowing the heart rate and relaxing the blood vessels thus improve blood flow and lowers blood pressure.
Nonselective Beta-Blockers
Carvedilol belongs to the Nonselective Beta-Blockers class of medicines. Nonselective beta-blockers are a subclass of beta-blockers that are used for the treatment of high blood pressure.

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How to use

Read the medicine guide provided by your pharmacist, your doctor, or the medicine company. If you have any questions related to Carvedilol, ask your doctor or pharmacist. Use Carvedilol as per the instructions provided by your doctor.
Carvedilol is eaten with food. Carvedilol should be taken with food to steady the rate of absorption and minimize the risk of low blood pressure when standing up from sitting or lying down.

Typical Dosage

The typical dose of Carvedilol for adults is 25 mg twice daily. The maximum dose for adult patients of Carvedilol is 50 mg twice daily per day. This medicine is generally used for a period of 2 weeks for heart failure, and 7 to 14 days for high blood pressure. Carvedilol is commonly used at the same time every day.
Carvedilol should be used as directed by the doctor even if you feel well, or even if you think that there is no need for you to use your medicine.

Talk to Your Doctor

Discuss with your doctor if your condition persists or worsens or if you develop new symptoms. Discuss with your doctor if extreme thirst, difficulty in swallowing, frequent urination, swelling of the legs, extreme hunger, weakness, tiredness, blurred vision, shortness of breath, weight gain, chest pain, hives, difficulty in breathing, irregular heartbeat, diarrhea, vomiting, cough, and joint pain. If you have any kidney disease, a reduced dose of Carvedilol is usually prescribed in case of worsening of the functioning of the kidneys. If you have issues with the health of your liver, Carvedilol should not be given to patients with severe liver abnormality. Consult with your doctor before stopping the use of Carvedilol.
Your doctor may prescribe a lower starting dose of this medicine to understand the impact on the body. Please follow your doctor's recommendations. A lower dose of this medicine may be recommended to reduce the risk of side-effects.
When stopping this medicine, some patients may experience withdrawal symptoms like chest pain, and heart attack. You may need to taper (gradually decrease) the dose of this medicine when stopping.

Use in Children

The safety and effectiveness of using Carvedilol in children has not been established.

Avoid Alcohol

Avoid consuming alcohol together with Carvedilol.
Medicines may be recommended for uses other than those listed in the medicine guide. You should not use Carvedilol for conditions or symptoms for which it was not prescribed. Do not give Carvedilol to other people, even if they have the same conditions or symptoms that you have. The use of this medicine without the advice of a doctor may cause harm.

Storage

Follow storage instructions on the product package if available. Store Carvedilol at room temperature, less than 86°F (30°C), away from excess heat and moisture, and keep it in a light-resistant container. Store this medicine away from children and pets.

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How to take Carvedilol

The dose and frequency of using Carvedilol will depend on the following factors:
  • the weight of the patient
  • patient's health
  • the health of the patient's liver
  • the health of the patient's kidneys
  • medicines recommended by the doctor
  • any other medicines being used
  • herbal supplements being used
  • response to the medicine

Carvedilol Dosage

Dosage for Heart failure

Adult
  • Initial: 3.125 mg twice daily for 2 weeks and the dose can be increased to 6.25, 12.5, and 25 mg twice daily at intervals of at least two weeks depending upon the patient's tolerability
  • Maximum: 25 mg twice daily in patients with a body weight of less than 85 kg (187.4 lb) and 50 mg twice daily in patients weighing more than 85 kg (187.4 lb)

Dosage for Heart disease (left ventricular dysfunction)

Adult
  • Recommended: 6.25 mg twice daily and can be increased after 3 to 10 days to 12.5 mg twice daily based on patient's tolerability, then target dose of 25 mg twice daily
  • Initial: 3.125 mg twice daily

Dosage for High blood pressure

Adult
  • Initial: 6.25 mg twice daily which can be increased after 7 to 14 days to 12.5 mg twice daily and adjusted to 25 mg twice daily if needed depending upon the patient's condition and tolerability
  • Maximum: 50 mg

Minimum Age

18 years

Forms

Capsule, extended release
Strength: 10 mg, 20 mg, 40 mg, 80 mg
Tablet
Strength: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg, and 50 mg
Tablet coated
Strength: 3.125 mg, 6.25 mg, 12.5 mg, and 25 mg
Tablet, film coated
Strength: 3.125 mg, 6.25 mg, 12.5 mg, and 25 mg

Missed Dose

The missed dose should be taken as soon as you remember it. However, if it is less than 12 hours before the next dose is scheduled, the missed dose should be skipped, and the regular dosing schedule should be continued. A double dose should not be taken to make up for a missed dose.

Overdose

What to do if you overdose on Carvedilol?
During an overdose of Carvedilol, proper monitoring of vital parameters is required under absolute care conditions. Atropine can be used for excessive low heart rate, while to support ventricular function sympathomimetics are recommended. If improved cardiac contractility is required, phosphodiesterase inhibitors should be considered. In case of drug-resistant low heart rate, the device generating electrical impulses (pacemaker therapy) should be used. To control the constriction of bronchial smooth muscles, β-sympathomimetics are used in the form of aerosol or injected directly into veins. To prevent an event of seizures, slow intravenous injection of diazepam or clonazepam is recommended. Standard supportive treatment should be provided until the individuals have shown improvement.
Symptoms of an overdose of Carvedilol
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
  • generalized seizures
  • heart attack
  • heart failure
  • insufficient blood flow and oxygen supply
  • loss of consciousness
  • narrowing of the airway muscles
  • respiratory problems
  • severe low blood pressure
  • slow heartbeat
  • vomiting
If you think you have overdosed on Carvedilol, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Carvedilol

Before you use Carvedilol, tell your doctor of your medical and health history including the following:
  • asthma
  • diabetes
  • heart problems
  • hormone-secreting tumor (pheochromocytoma)
  • kidneys problems
  • liver problems
  • lung problems (for example, bronchitis or emphysema)
  • poor blood circulation that makes the fingers and toes numb and pale (Raynaud's phenomenon)
  • problems with blood flow in the feet and legs (peripheral vascular disease)
  • regular wearing of contact lenses
  • severe allergic reactions
  • skin condition known as patches of abnormal skin
  • thyroid problems
This medicine may hide the symptoms of low blood sugar level, and use of Carvedilol may also cause dry eyes.
Before you use Carvedilol, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information.
Before having any surgery, discuss with your doctor and dentist about medicines you use including prescription medicines, non-prescription medicines, and herbal supplements.
The use of Carvedilol may change liver enzymes. This medicine may increase the level of liver enzymes.

Use when Pregnant

Carvedilol should be used only when required in patients who are pregnant or planning to become pregnant. There are not enough and well-controlled studies in the pregnant women. This medicine should only be used during pregnancy if the potential benefit is more significant than the potential risk to the baby.

If Breastfeeding

Carvedilol is not safe for use in women who are breastfeeding. If you are breastfeeding, discuss with your doctor if you should either discontinue breastfeeding, or stop using this medicine during this period. This medicine may pass into breast milk. If a breastfeeding mother uses this medicine, it is advised to discontinue breastfeeding. Besides, beta blockers including Carvedilol can cause serious side effects in babies including slow heart rate.

If trying to Conceive

Consult with your doctor on the use of Carvedilol, if you are trying to conceive.

Alcohol

Seizures

Carvedilol can make you feel sleepy. Be careful, especially while driving, while using heavy machinery, or when doing any activity that needs you to be completely alert. The consumption of alcohol with Carvedilol can worsen the sleepiness. Carvedilol may cause seizures in some people. Hence, you should discuss with your doctor before performing any activities where a loss of consciousness may cause harm to you or others.

Increase in Risk

This medicine may cause stomach bleeding. Regular use of tobacco or alcohol may increase the risk. Discuss with your doctor if you smoke and drink alcohol regularly. This medicine may increase your sensitivity to sunlight and make you prone to sunburn. If this happens, limit your time outdoors to prevent sunburn. Use a sunscreen and cover your skin.

Side-effects in Older Patients

Older patients may have a higher incidence of side-effects when using Carvedilol. Elderly patients may see an increased risk of dizziness.

Side-effects in Children

Younger patients may have a higher incidence of side-effects with Carvedilol. Younger patients may see an increased risk of chest pain, dizziness, and shortness of breath.

Carvedilol Side-effects

The following side-effects may commonly occur when using Carvedilol. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
Rarely, the use of Carvedilol may cause the following side-effects:
The following severe side-effects may also occur when using Carvedilol:
  • Psychiatric disorders
  • Metabolism and nutritional disorders
    Symptoms: weight increase, high cholesterol level, high blood sugar low blood sugar
    Daily monitoring of blood glucose level is advised to the patient taking Carvedilol.
  • Immune system disorders
    Symptoms: allergic reaction
    Care should be taken when giving Carvedilol to patients with a history of serious allergic reactions.
  • Blood and lymphatic system disorders
    Symptoms: a decrease in number of red blood cells, abnormally low levels of thrombocytes a decrease in the number of white blood cells
  • Infections and infestations (Possibly fatality)
    Symptoms: chest cold, an infection of the lungs, infection that affects the nose, throat, and airways (upper respiratory tract infection), an infection affecting the kidneys bladder or urethra (urinary tract infection)
    Caution should be taken while taking Carvedilol. The effective dose should be lowered if there is any evidence of infection of the lungs.
  • Heart disorders
    Symptoms: heart failure, decreased heart rate, fluid overload, heart block (atrioventricular block) chest pain (angina pectoris)
    If decreased heart rate appears or in case of lengthening of heart block, the level of digoxin should first be observed. It may be necessary to lower the dose of Carvedilol or temporarily discontinue therapy altogether.
  • Vascular disorders
    Symptoms: low blood pressure, low blood pressure while standing up from sitting or lying down, cold extremities, reduced blood flow to the limbs (peripheral vascular disease), burning pain in the legs reduced blood flow to the arms and legs (Raynaud's phenomenon)
    Patients should be kept on moderate doses if larger doses are not tolerated. Caution should be taken in these individuals.
  • Respiratory, thoracic and mediastinal disorders
    Symptoms: shortness of breath, pulmonary swelling narrowing of the airways of the lungs
  • Stomach and intestinal disorders
    Symptoms: diarrhea vomiting
  • Kidney and urinary disorders
    Symptoms: kidney failure, abnormal functioning of the kidneys, kidney insufficiency, disturbances of the storage function of the bladder, and emptying function uncontrolled leakage of urine
    In heart failure patients with risk factors such as (low blood pressure, heart attack, and narrowing of the arteries), the functioning of kidneys should be monitored during dose titration of Carvedilol. If significant worsening of the functioning of kidneys occurs, the Carvedilol dose must be decreased, or medicine must be discontinued.
Your doctor has prescribed this Carvedilol because they have judged that the benefits outweigh the risks posed by side-effects. Many people using this medicine do not have serious side-effects. This is not a complete list of possible side-effects for Carvedilol.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Recurrent chest pain

Agents with β-blocking activity (non-selective ) may produce chest pain in patients with recurrent chest pain (Prinzmetal’s variant angina). Caution should be used when Carvedilol is taken by patients doubted of having recurrent chest pain.

Risk of an allergic reaction

Patients with a history of severe allergic reaction to a variety of allergens are at an increased risk while using this medicine. These patients may be unresponsive to the normal doses of epinephrine used to manage an allergic reaction.

Flaccid iris

Flaccid iris (intraoperative floppy iris syndrome) has been seen during cataract surgery in patients treated with Carvedilol. Stopping alpha-1 blocker treatment including Carvedilol before cataract surgery is not beneficial.

Tumor of the adrenal gland (pheochromocytoma)

Patients suspected of having a tumor of the adrenal gland are at an increased risk when using this medicine. Proper care should be taken when using Carvedilol in patients suspected of having adrenal gland tumor.

Levels of sugar in type-2 diabetes

Patients with diabetes mellitus and heart failure are at an increased risk when using this medicine. β-blockers may mask the symptoms of low blood pressure, particularly of abnormal heart rhythms. Close monitoring of diabetic patients is required by measuring regular blood glucose measurements, especially during dose titration. Dose adjustment of antidiabetic medicines is also required in diabetic patients using Carvedilol.

Reduced blood flow to the limbs

β-blockers including Carvedilol can increase symptoms of stoppage of blood flow through the arteries in patients with reduced blood flow to the limbs. Caution should be taken in patients with reduced blood flow to the limbs (peripheral vascular disease).

Worsening of the functioning of kidneys

Patients with low blood pressure, recurring chest pain, and diffuse vascular disease, or kidney insufficiency are at an increased risk while using this medicine. Use of Carvedilol in patients with heart failure has resulted in worsening of the functioning of kidneys. Patients with these risk factors are recommended to discontinue the use of Carvedilol or to reduce the dose during the worsening of the functioning of the kidney.

Major surgical procedures

The reduced ability of the heart to respond to spontaneous adrenergic stimuli may increase the risks of general anesthesia and medical procedures. Long-term use of beta-blocking therapy should not be routinely withdrawn before to major surgery.

Excessive production of thyroid hormone

β- blockers may hide clinical signs of an overactive thyroid, such as increased heartbeat. Sudden withdrawal of β-blockers should be followed in case of worsening of the symptoms of overactive thyroid (thyroid storm).

Discontinuation of therapy

Patients with blockage of the coronary artery are at an increased risk while using this medicine. Severe worsening of angina and the occurrence of heart attack and irregular heartbeat have been seen in angina patients following the sudden discontinuation of treatment with β-blockers. Discontinue the use of Carvedilol over 1-2 weeks. If chest pain worsens or blockage of blood flow to the heart develops, use of Carvedilol must immediately begin again, at least temporarily. Patients are advised to limit their physical activities. During the worsening condition of angina, it is recommended to reinstitute the Carvedilol.

Decreased heart rate

Patients with high blood pressure, heart failure, and heart attack are at an increased risk while using this medicine. Carvedilol caused decreased heart rate in about 2% of high blood pressure patients, 9% of heart failure patients, and 6.5% in patients affected from heart attack. The dose should be reduced if pulse rate falls below 55 beats/minute.

Low blood pressure

Patients with high blood pressure are at an increased risk while using this medicine. Heart failure, severe fall in blood pressure while standing up from a lying or sitting position and temporary loss of consciousness occurred in patients receiving Carvedilol. The chances of these events were higher during the first 30 days of dosing and was a reason for discontinuation of therapy. While starting of therapy, the patients are advised to avoid situations such as driving or hazardous tasks, where injury leads to the condition of fainting.

Heart failure/fluid retention

Use of Carvedilol may lead to the worsening condition of heart failure, or fluid retention. If such events occur, it is advised to lower the dose of Carvedilol or temporarily discontinue it.

Non-allergic Bronchospasm

Patients with bronchospastic diseases (inflammation of the lining of bronchial tubes and damage to the alveoli in the lungs) are at an increased risk while using beta blockers. Carvedilol may be used with caution, in patients who cannot tolerate or do not respond to other antihypertensive agents. The dosing recommendations should be accompanied closely and the dose should be lowered if any sign of reversible reflex contraction of the smooth muscle in the bronchi is recognized.

Interactions with Carvedilol

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
This page does not contain all the possible interactions of Carvedilol. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Immunosuppressant Agent

Carvedilol interacts with immunosuppressant agent (cyclosporine), which is used to prevent organ rejection during transplantation procedure. Use of Carvedilol with cyclosporine may lead to an increase in the level of cyclosporine in patients suffering from vascular rejection. Carefully monitor the dose of cyclosporine in these patients after starting the treatment with Carvedilol.

Blood Pressure Lowering Agents

There may be an interaction of Carvedilol with blood pressure lowering agents (clonidine), which are used to lower the high blood pressure. Use of clonidine with β-blocking agents including Carvedilol may potentiate the condition of blood pressure and heart rate lowering effects. To prevent these effects, discontinue the use of β-blocking agent first followed by discontinuation of clonidine therapy several days later by gradually decreasing the dosage.

CYP2D6 Inhibitors and Poor Metabolizers

Carvedilol may interact with CYP2D6 inhibitors, which are used in the metabolism of xenobiotics in the body. Interactions of Carvedilol with effective inhibitors of CYP2D6 isoenzyme (such as fluoxetine, quinidine, propafenone, and paroxetine) expected to raise blood levels of the enantiomer of Carvedilol.

Inducers/Inhibitors of Liver Metabolism

Your doctor's guidelines may need to be followed while taking this medicine along with rifampin and cimetidine, which are used to treat bacterial infections, heartburn and stomach ulcers. Rifampin reduced blood levels of Carvedilol by about 70%. Cimetidine increased the level of Carvedilol in the blood by about 30% but produced no change in maximum levels of Carvedilol in the blood. Follow proper care to the patients using both rifampicin and cimetidine with Carvedilol.

Cardiac Glycosides

Special instructions need to be followed while taking this medicine along with digitalis, which is used to treat various heart conditions such as irregular or rapid heart rate and heart failure. The combined use of Carvedilol and digoxin may lead to increased levels of digitoxin in hypertensive patients. Proper monitoring of the level of digoxin in the blood is recommended when initiating, discontinuing or adjusting treatment with Carvedilol.

Non-Steroidal-Anti-Inflammatory Drugs

Your doctor's guidelines may need to be followed while taking this medicine along with NSAIDs, which are used to reduce pain, fever, inflammation and prevents the blood clot formation. Use of NSAIDs may lead to the decreased antihypertensive effect of Carvedilol due to sodium and water retention.

Inhalational Anaesthetics

Special instructions need to be followed while taking this medicine along with inhalational anesthetics (ether, cyclopropane, and trichloroethylene), which are used for sedation purposes during surgical procedures for the management of the pain. Use of anesthetic agents (ether, cyclopropane, and trichloroethylene) with Carvedilol may depress the blood pumping function of the heart. Take necessary precautions while using anesthetic agents with Carvedilol.

Antidiabetics including Insulin

Carvedilol interacts with antidiabetics including insulin, are used to treat diabetes mellitus by lowering the blood glucose levels. Use of Carvedilol with antidiabetics including insulin may lead to increased blood sugar lowering effect of insulin and oral diabetic medicines. Carvedilol may also hide the symptoms of low blood sugar levels. Proper monitoring of blood glucose levels is required in diabetic patients.

Calcium Channel Blockers

There may be an interaction of Carvedilol with calcium channel blockers (verapamil or diltiazem), which are used to decrease the high blood pressure condition. Disturbances in electrical conduction, heart failure, and severe decreased blood pressure have been observed when Carvedilol is used in combination with diltiazem. If Carvedilol is to be taken with calcium channel blockers of the diltiazem or verapamil type, it is advised that ECG and blood pressure should be monitored.

Antiarrhythmics

Carvedilol may interact with antiarrhythmics (amiodarone), which are used to suppress irregular heartbeats. The combined use of amiodarone or other CYP2C9 inhibitors such as fluconazole with Carvedilol may increase the β-blocking properties of Carvedilol which leads to the slowing of the heart rate or cardiac conduction. Patients should be observed for symptoms of low heart rate or heart block, mainly when a combination of medicines is started.

Estrogens and Corticosteroids

Your doctor's guidelines may need to be followed while taking this medicine along with estrogens and corticosteroids, which are used to prevent pregnancy, asthma and joint problems. Use of estrogens and corticosteroids with Carvedilol may lead to the decreased antihypertensive effect of Carvedilol due to sodium and water retention.

Sympathomimetics

Special instructions need to be followed while taking this medicine along with sympathomimetics with alpha-mimetic and beta-mimetic effects, which are used to treat cardiac arrest and low blood pressure conditions. There is a risk of high blood pressure and excessively decreased heartbeat on using both Carvedilol and sympathomimetics.

Vasoconstrictor

Carvedilol interacts with vasoconstrictor (ergotamine), which is used medicinally for treatment of acute migraine attacks. The combined use of Carvedilol and ergotamine may lead to increased constriction of the blood vessels.

Neuromuscular Blocking Agents

There may be an interaction of Carvedilol with neuromuscular blocking agents, which are potent muscle relaxants. The combined use of Carvedilol and neuromuscular blocking agents may lead to blockage of neuromuscular transmission at the neuromuscular junction, causing paralysis of the affected skeletal muscles.

Vasodilators

Carvedilol may interact with Vasodilators (nitrates), which are used to relax the blood vessels and improves the blood flow. The combined use of both medicines increases blood pressure lowering effects.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Carvedilol is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.
This page provides information for Carvedilol .
Heart Failure
Heart Diseases
Heart Attack
High Blood Pressure

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