Carvedilol (Oral)

Carvedilol stops the action of some substances on your body, which lessens the workload on the patient's heart.

Overview

Carvedilol is a beta blocker. This means that it can stop the action of some substances in the body, such as epinephrine, on certain parts of the body, such as epinephrine's action on the heart and blood vessels. This can both lessen the workload placed on the heart and make the cardiovascular system more efficient. As a result, the drug is effective in treating a multitude of different heart and cardiovascular conditions. It was first approved in 1995 for the treatment of hypertension. Since then, carvedilol has been found to be effective in preventing (or at least decreasing the chance of) congestive heart failure and in protecting the heart from long-term damage due to heart attacks.

SmithKline Beecham (now GlaxoSmithKline) first brought the medicine to market in 1995 under the brand name Coreg. Since then, Carvedilol has been made available in generic form by a wide variety of different labs and manufacturers.

Conditions Treated

Type of Medicine

  • Beta-blocker

Side Effects

Carvedilol, because of its wide-reaching mechanism of action, can cause a large number of different side effects spanning a wide variety of different symptoms. These symptoms can be indicative of serious medical concerns or may simply be the result of the patient's body adapting to the carvedilol. The side effects listed below are usually considered symptoms of serious medical concerns brought on by carvedilol. Patients who experience any of the following symptoms after taking carvedilol should contact their doctor immediately.

The most common serious side effects can include:

  • Chest pain, discomfort, or other irregular feelings
  • Dizziness
  • Lightheadedness
  • Fainting
  • Swelling, especially of the lower extremities
  • Pain (generalized or specific)
  • Shortness of breath
  • Depressed heart rate
  • Sudden weight gain

The following side effects occur at a lower rate than the ones listed above but are still prevalent. Patients who experience any of the following side effects should contact their doctor immediately:

  • Joint pain, especially in the lower legs and feet
  • Increased or irregular urination
  • Suddenly increased or irregular urinary habits
  • Bloody or discolored urine
  • Anxiety (new or worsening)
  • Itching
  • Pain in the arms, back, or jaw
  • Stiff or swollen joints
  • Significant increases in blood cholesterol
  • Bloody, blackened, or otherwise affected bowel movements
  • Appetite loss
  • Sudden appetite gain
  • Chills
  • Loss of consciousness
  • Pain in the lower back, side, abdominals, or stomach
  • Cold sweats
  • New or worsening depression
  • Coma
  • Rogue muscle pain or cramping
  • Nervousness
  • Confusion
  • Nightmares
  • Convulsions
  • Seizures
  • Cold, pale skin
  • Noisy breathing (especially if breathing sounds 'rattly')
  • Numbness or tingling in the extremities or the lips
  • Coughing
  • Pinpoint spots of red or purple developing on the patient's skin
  • Pounding in the ears
  • Slow or pounding heartbeat
  • Fast and/or shallow breathing
  • Difficulty breathing
  • Sudden dizziness or lightheadedness when the patient rises from a prone or seated position
  • Shakiness
  • Slurred speech
  • Dry mouth
  • Stomach aches
  • Rogue sweating
  • Fast or irregular heartbeat
  • Arrhythmia
  • Swelling of the fingers or hands
  • Fever
  • Blindness (temporary)
  • Flu-like symptoms
  • Tenderness, especially in the upper right side of the body
  • Flushed or dried out skin
  • Difficulty breathing when at rest
  • Rogue breath odors, especially a fruit like odor
  • Sudden or unexplained weight loss
  • Sudden onset of severe headaches
  • Unusual or unexplained bleeding and bruising
  • Sudden loss of voice
  • Sudden weakness in one side of the body
  • Sudden weakness in the legs
  • Increased or decreased thirst
  • Discolored or yellow eyes or skin

In some cases, patients have experience wheezing, swollen and painful glands, and sudden sores or discoloration of the lips. The incidence of the side effects has not been determined. Patients who experience any of the following side effects should contact their doctor immediately, as they may require medical attention.

Not all of the side effects caused by carvedilol necessarily demand immediate attention. Carvedilol can be hard on the body, and the patient's body might just need time to adjust to the new carvedilol treatment. Patients should contact their doctor if they begin to experience any of the following side effects to determine how best to mitigate or decrease the unwanted effects.

The most common of the less severe side effects can include:

  • Back pain
  • Diarrhea
  • Prickling or tingling sensations (pins and needles)
  • Unusual tiredness
  • Unusual weakness

The following side effects are less common than those listed above but are still prevalent. Patients who experience any of the following side effects should contact their doctor to determine how best to mitigate or otherwise lessen the unwanted effects.

  • Stomach or abdominal pain
  • Loose teeth
  • Bleeding gums
  • Reddened or swollen gums
  • Sudden loss of sex drive or ability
  • Erectile dysfunction
  • Blurred or otherwise affected vision
  • Sudden loss of energy
  • Sudden loss of strength
  • Muscle aches
  • Muscle stiffness
  • Nausea
  • Persistent halitosis
  • Persistent and rogue foul mouth tastes
  • Decreased tearing
  • Rogue spinning sensations
  • Persistent feelings of motion, even while at rest
  • Difficult or labored movement
  • Sleepiness or unusual drowsiness
  • Sore throat
  • Stuffy nose
  • Runny nose
  • Generalized feelings of discomfort or illness
  • Excretion of sugar through the urine
  • Headache
  • Insomnia
  • Vomiting
  • Increased sweating
  • Weight loss

This is not necessarily a complete list of side effects. Patients who begin to experience new symptoms or effects after beginning taking carvedilol should contact their doctor immediately. The patient can report new side effects to the FDA at 1 900 FDA 1088 or www.fda.gov/medwatch.

Dosage

For treatment of congestive heart failure:

Patients taking the immediate release capsule of carvedilol will usually be prescribed an initial dose of carvedilol of 3.125 mg twice daily for two weeks. If the patient's body proves amenable to the carvedilol, the dose can be upped to 6.25, 12.5, and then 25 mg doses twice daily. These increases are usually performed at two-week intervals.

The maximum dose for patients under 85 kilograms is generally considered to be 25 mg orally taken twice daily. Patients over 85 kilograms can sometimes be prescribed a dose as high as 50 mg twice daily.

Patients using the extended-release form of carvedilol follow a similar dosage pattern. The initial dose is typically 10 mg tablets taken daily, increased to 20 mg, 40 mg, and 80 mg doses until the effective dose is found. 80 mg daily is considered to be the maximum dose for the extended release form of carvedilol.

Carvedilol should be taken with food. By taking carvedilol with food, patients will slow the release of carvedilol into the body, lowering the risk of side effects and prolonging the effects of the carvedilol.

Carvedilol is most effective in increasing the chance of surviving congestive heart failure when used in conjunction with a full suite of drugs designed to help the patient survive.

For treatment of hypertension (high blood pressure):

The standard starting dose for treatment of hypertension is 6.25 mg doses of carvedilol taken twice daily. If this dose is tolerated, it is usually sustained for one to two weeks, then increased to 12.5 mg twice daily. If, after two weeks, the body is tolerating the 12.5 mg twice daily dose effectively, the dosage is usually increased to 25 mg twice daily.

Patients taking the extended release form of carvedilol to treat hypertension typically receive an initial dose of 20 mg daily to begin with. After one to two weeks of monitoring the effects of carvedilol on the patient and their condition, the dose can be raised to 40 mg daily. If that dose proves tolerable, then after one to two weeks the dose may be raised to 80 mg daily. The purpose of this fragmented increase in dosage is to determine, by trial-and-error, the lowest effective dosage for treating the patient's condition.

80 mg daily is considered the maximum dosage for the extended release formulation of carvedilol.

Patients should exercise caution when considering stopping taking carvedilol. Abrupt cessation of carvedilol may have serious effects, including increased angina and heightened risk of heart attack or congestive heart failure. It typically takes one to two weeks to discontinue use of carvedilol. Patients should consult with their doctor to determine the best way to stop taking carvedilol.

Patients who have missed a dose of carvedilol should take their dose as soon as they remember. In the events that it is nearly time for their next dose, they should simply forgo the dose they missed. Under no circumstances should a patient take double their dosage to make up for missed doses.

The information given here is an aggregate of best practice, typical procedures, and more. It may not be pertinent to specific cases. Patients should follow the directions given by their doctor for dosage and usage.

Interactions

Patients who take multivitamins which are fortified by minerals should be aware that their multivitamin can cause a decrease in carvedilol effectiveness. To minimize interaction, patients should separate the time they take carvedilol and the time they take the multivitamin fortified with minerals by at least two hours. Patients may want to consider finding an alternative multivitamin to take in the event they must take carvedilol. Patients should consult with their doctor to determine how best to handle the interaction between carvedilol and multivitamins fortified with minerals. Patients should disclose a complete list of the drugs, medications, and supplements they are taking prior to deciding to take carvedilol.

Carvedilol can wreak havoc on cholesterol levels. Patients with otherwise high cholesterol should be closely monitored if they must take carvedilol. Typically, patients cholesterol levels are monitored for the duration of time they are on carvedilol. Patients should fully apprise their doctor to the different medical conditions they suffer from prior to deciding to take carvedilol.

The following diseases interact negatively with carvedilol, typically having their symptoms being exacerbated by the carvedilol:

The following diseases interact with carvedilol, but to a lesser extent than the ones listed above. Patients with any of the following diseases may want to seek alternative treatment if they must take carvedilol. Patients should consult with their doctor to determine how best to deal with any possible interactions. Patients should ensure that their doctor is fully apprised of all medical conditions they suffer from before deciding to take carvedilol.

Patients who take any medicines such as albuterol to treat asthma or other breathing problems should be aware that these medications can react severely and negatively to one another. Interactions can include the significant cuts to the effectiveness of both medicines, new or worsening breathing problems, or sudden and severe asthma attacks. Patients who are taking medications to treat their breathing problems should consult with their doctor before deciding to take carvedilol. Patients should disclose a full list of all medications, drugs, and supplements they are taking to their doctor prior to deciding to take carvedilol.

Carvedilol can interact negatively with anti-inflammatory agents such as colchicine. Interactions between carvedilol and anti-inflammatory agents can include effects on the muscular system, cardiovascular system, and a variety of organs including the liver and kidneys. Additionally, carvedilol can raise blood levels of colchicine to dangerous levels, raising the risks of side effects and putting the patient at risk of overdose. Patients may need a major dose adjustment of carvedilol if they need to take the drug within a two week to one month period of taking an anti-inflammatory agent. Patients should consult with their doctor to determine how best to handle the potential interaction. Patients should disclose a full list of all medications, drugs, and supplements they are taking to their doctor prior to deciding to take carvedilol.

The following drugs can interact severely and negatively with carvedilol. Patients who are taking any of the following drugs may want to consider an alternative to carvedilol if they have to take the drug. Patients should consult with their doctor to determine the best way to handle the possible interactions. The patient should disclose a full list of all the drugs, medications, and supplements they are taking prior to deciding to take carvedilol.

  • Albuterol
  • Aminophylline
  • Arformoterol
  • Atazanavir
  • Betrixaban
  • Bitolterol
  • Clonidine
  • Colchicine
  • Edoxaban
  • Epinephrine
  • Fingolimod
  • Formoterol
  • Fluticasone
  • Indacaterol
  • Isoetharine
  • Levalbuterol
  • Metaproterenol
  • Methacholine
  • Methyldopa
  • Mixed grass pollens allergen extract
  • Olodaterol
  • Oxtriphylline
  • Pirubuterol
  • Racepinephrine
  • Ragweed pollen allergen extract
  • Ritodrine
  • Salmeterol
  • Saquinavir
  • Terbutaline
  • Theophylline
  • Timothy grass pollen allergen extract
  • Tizanidine
  • Venetoclax
  • Verapamil

The following drugs can interact with carvedilol in a negative way, but typically less severely than the drugs listed above. Patients who take any of the following drugs may want to consider an alternative to carvedilol if they have to take the drug. Patients should consult with their doctor to determine how best to handle possible interactions. Patients should disclose a full list of all the medications, drugs, and supplement shtye are taking to their doctor prior to deciding to take carvedilol.

  • Abiraterone
  • Acetohexamide
  • Acetylcarbromal
  • Aldesleukin
  • Alectinib
  • Alfentanil
  • Alfuzosin
  • Aliskiren
  • Alprazolam
  • Amifostine
  • Amiodarone
  • Amitriptyline
  • Amlodipine
  • Amobarbital
  • Amoxapine
  • Antivenin (black widow spider)
  • Antivenin (crotalidae) polyvalent
  • Antivenin (micrurus fulvius)
  • Apomorphine
  • Apraclonidine ophthalmic
  • Arbutamine
  • Aripiprazole
  • Asenapine
  • Atracurium
  • Atropine
  • Avanafil
  • Baclofen
  • Benzthiazide
  • Benztropine
  • Bepridil
  • Betamethasone
  • Betaxolol
  • Biperiden
  • Brexpiprazole
  • Brigatinib
  • Brimonidine
  • Bromfenac
  • Bromocriptine
  • Budesonide
  • Bumetanide
  • Bupivacaine
  • Buprenorphine
  • Bupropion
  • Buspirone
  • Butabarbital
  • Butalbital
  • Butorphanol
  • Cabergoline
  • Calcium acetate
  • Calcium carbonate
  • Calcium citrate
  • Calcium glubionate
  • Calcium gluconate
  • Calcium lactate
  • Calcium phosphate, tribasic
  • Canagliflozin
  • Cariprazine
  • Carisoprodol
  • Carteolol
  • Celecoxib
  • Ceritinib
  • Cevimeline
  • Chloral hydrate
  • Chlordiazepoxide
  • Chlormezanone
  • Chlorothiazide
  • Chlorpromazine
  • Chlorpropamide
  • Chlorthalidone
  • Chlorzoxazone
  • Cimetidine
  • Cinacalcet
  • Cisatracurium
  • Citalopram
  • Clevidipine
  • Clidinium
  • Clobazam
  • Clomipramine
  • Clonazepam
  • Clorazepate
  • Clozapine
  • Cobicistat
  • Codeine
  • Corticorelin
  • Corticotropin
  • Cortisone
  • Cosyntropin
  • Crizotinib
  • Cyclobenzaprine
  • Cyclosporine
  • Dabigatran
  • Dalfampridine
  • Dapagliflozin
  • Deflazacort
  • Dezocine
  • Diatrizoate
  • Diazepam
  • Diclofenac
  • Dicyclomine
  • Digitoxin
  • Digoxin
  • Dihydroergotamine
  • Diphenhydramine
  • Dobutamine
  • Docetaxel
  • Donepezil
  • dopamine
  • Doxacurium
  • Doxazosin
  • Doxepin
  • Dronedarone
  • Duloxetine
  • Eliglustat
  • Empagliflozin
  • Ephedrine
  • Epoprostenol
  • Ergonovine
  • Ergotamine
  • Estazolam
  • Ethacrynic acid
  • Ethanol
  • Ethchlorvynol
  • Ethiodized oil
  • Etodolac
  • Felodipine
  • Fenoldopam
  • Fenoprofen
  • Fentanyl
  • Flecainide
  • Fluconazole
  • Fludrocortisone
  • Fluorescein
  • Fluoxetine
  • Fluphenazine
  • Flurazepam
  • Flurbiprofen
  • Fluvoxamine
  • Furazolidone
  • Furosemide
  • Gadobenate dimeglumine
  • Gadobutrol
  • Gadodiamide
  • Gadofosveset trisodium
  • Gadopentetate dimeglumine
  • Gadoterate meglumine
  • Gadoteridol
  • Gadoversetamide
  • Gadoxetate disodium
  • Galantamine
  • Glimepiride
  • Glipizide
  • Glyburide
  • Glycerol phenylbutyrate
  • Glycopyrrolate
  • Guanadrel
  • Guanethidine
  • Guanfacine
  • Halazepam
  • Haloperidol
  • Heroin
  • Hydrocortisone
  • Hydroflumethiazide
  • Hydromorphone
  • Hydroxyzine
  • Hyoscyamine
  • Ibuprofen
  • Iloperidone
  • Iloprost
  • Imatinib
  • Imipramine
  • Indapamide
  • Indomethacin
  • Insulin
  • Iodamide
  • Iodipamide
  • Iodixanol
  • Iohexol
  • Iopamidol
  • Iopromide
  • Iothalamate
  • Ioversol
  • Ioxaglate
  • Ioxilan
  • Ipodate
  • Isocarboxazid
  • Isoproterenol
  • Isradipine
  • Ivabradine
  • Ketoprofen
  • Ketorolac
  • Lacosamide
  • Lanreotide
  • Lanthanum carbonate
  • Levobetaxolol ophthalmic
  • Levobunolol ophthalmic
  • Levodopa
  • Licorice
  • Lidocaine
  • Linezolid
  • Lithium
  • Lorazepam
  • Lorcaserin
  • Loxapine
  • Lurasidone
  • Maprotiline
  • Maraviroc
  • Meclofenamate
  • Mefenamic acid
  • Mefloquine
  • Meloxicam
  • Mepenzolate
  • Meperidine
  • Mephentermine
  • Mephobarbital
  • Meprobamate
  • Mesoridazine
  • Metaraminol
  • Metaxalone
  • Methadone
  • Methdilazine
  • Methimazole
  • Methocarbamol
  • Methotrimeprazine
  • Methoxyflurane
  • Methscopolamine
  • Methyclothiazide
  • Methylergonovine
  • Methylprednisolone
  • Methysergide maleate
  • Metipranolol ophthalmic
  • Metocurine
  • Metolazone
  • Metrizamide
  • Mibefradil
  • Midodrine
  • Mirabegron
  • Mirtazapine
  • Mivacurium
  • Molindone
  • Morphine
  • Morphine liposomal
  • Multivitamin with minerals
  • Multivitamin, prenatal
  • Nabumetone
  • Nalbuphine
  • Naldemedine
  • Naproxen
  • Nateglinide
  • Nefazodone
  • Neostigmine
  • Nicardipine
  • Nifedipine
  • Nilotinib
  • Nimodipine
  • Nisoldipine
  • Norepinephrine
  • Nortriptyline
  • Octreotide
  • Olanzapine
  • Opium
  • Orphenadrine
  • Oxaprozin
  • Oxazepam
  • Oxybutynin
  • Oxycodone
  • Oxymorphone
  • Paclitaxel
  • Peridone
  • Pancuronium
  • Panobinostat
  • Paraldehyde
  • Paroxetine
  • Pasireotide
  • Pentazocine
  • Pentobarbital
  • Pentoxifylline
  • Perphenazine
  • Phenelzine
  • Phenobarbital
  • Phenoxybenzamine
  • Phenylbutazone
  • Phenylephrine
  • Pilocarpine
  • Pipecuronium
  • Piroxicam
  • Polythiazide
  • Prazosin
  • Prednisolone
  • Prednisone
  • Primidone
  • Procarbazine
  • Prochlorperazine
  • Procyclidine
  • Promazine
  • Promethazine
  • Propafenone
  • Propantheline
  • Propiomazine
  • Propoxyphene
  • Propylthiouracil
  • Protriptyline
  • Quazepam
  • Quetiapine
  • Quinidine
  • Ranolazine
  • Rapacuronium
  • Rasagiline
  • Rauwolfia serpentina
  • Repaglinide
  • Reserpine
  • Rifampin
  • Riociguat
  • Risperidone
  • Ritonavir
  • Rivastigmine
  • Rocuronium
  • Rolapitant
  • Safinamide
  • Scopolamine
  • Secobarbital
  • Selegiline
  • Selexipag
  • Sertraline
  • Sildenafil
  • Silodosin
  • Sodium nitrite
  • Spironolactone
  • Succinylcholine
  • Sufentanil
  • Sulindac
  • Sunitinib
  • Tacrine
  • Temazepam
  • Terazosin
  • Terbinafine
  • Tetrabenazine
  • Tetrofosmin
  • Thalidomide
  • Thiethylperazine
  • Thioridazine
  • Thiothixene
  • Timolol ophthalmic
  • Tocainide
  • Tolazamide
  • Tolbutamide
  • Tolmetin
  • Tolterodine
  • Torsemide
  • Tranylcypromine
  • Trazodone
  • Treprostinil
  • Triamcinolone
  • Triamterene
  • Triazolam
  • Trichlormethiazide
  • Trifluoperazine
  • Triflupromazine
  • Trihexyphenidyl
  • Trimeprazine
  • Trimipramine
  • Trospium
  • Tubocurarine
  • Tyropanoate
  • Valsartan
  • Vardenafil
  • Vecuronium
  • Vemurafenib
  • Zaleplon
  • Zileuton
  • Ziprasidone
  • Zolpidem

This is not necessarily a complete list of medications, drugs, or supplements which interact with carvedilol. Patients should disclose a full list of all the medications, drugs, and supplements they are taking to their doctor prior to deciding to take carvedilol. Patients should follow the directions of their doctor when it comes to dealing with potential interactions.

Warnings

Beta blockers are banned from a number of different sports and competitions by the World Anti-Doping Agency (WADA). Patients who compete in the following sports should be aware that they may be disqualified for taking carvedilol:

  • Archery (WA)
  • Automobile (FIA)
  • Billiards (WCBS)
  • Golf (IGF)
  • Shooting (ISSF) (IPC)
  • Skiing (FIS) (in some events)
  • Snowboarding (FIS) (in some events)
  • Underwater Sports (CMAS) (in some events)

The sporting organizations which consider carvedilol a banned substance is listed in parentheses after the sporting discipline.

Carvedilol has not been approved for use in children under the age of 18. Patients under 18 should not take carvedilol.

Patients should avoid consuming alcohol (or products which contain alcohol) within 2 hours of taking extended release forms of carvedilol. By consuming alcohol within that two-hour window, patients may cause the carvedilol to be released too quickly into the body, putting the patient at risk of increased side effects, heightened effects, and possible overdose.

Improper dosages may increase the risk of heart failure. Patients should follow their doctor's direction to determine the most effective dosage for them.

Carvedilol can cause serious complications in patients with diabetes. In some cases, carvedilol can mask the symptoms of hypoglycemia. It can also raise the risk of hypoglycemia in diabetics, along with increasing the risk of heart failure in diabetics. Blood sugar levels should be closely monitored when a patient starts or stops taking carvedilol, or the dose is adjusted. Patients with diabetes may want to consider alternative treatments to carvedilol. Patients should disclose a complete list of the medical conditions they suffer from (including diabetes) to their doctor prior to deciding to take carvedilol.

Patients with asthma or other bronchospastic diseases should not take carvedilol. Carvedilol exacerbates conditions which cause difficult breathing, which can be dangerous in patients with asthma or other bronchospastic diseases.

In addition, patients with any pre existing difficulties breathing should exercise caution when considering taking carvedilol, as the drug (carvedilol) will exacerbate their condition. Patients should apprise their doctor of all medical conditions they suffer from before they decide to take carvedilol.

Patients with liver disease should not take carvedilol. Carvedilol is metabolized in the liver. Any impairment which slows the metabolization of carvedilol will cause increased concentrations of the drug in the patient's bloodstream, which can be dangerous. Patients with liver disease should consult with their doctor to determine the best alternative to carvedilol if they need to take the drug (carvedilol). Patients should disclose a complete list of the medical conditions they suffer from (including liver disease/liver impairment) to their doctor before deciding to take carvedilol.

Carvedilol may cause new or worsening circulatory disorders. Patients should be monitored for changes to their circulation, especially if they are predisposed to circulatory disorders.

Patients with renal impairment should exercise caution when taking carvedilol. To ensure maximum safety, patients with renal impairment who are taking carvedilol should be monitored by medical professionals for signs of trained interaction. Patients should follow the advice of their doctor to handle any possible interactions.

This is not necessarily a complete list of warnings. Patients should look to their doctor to provide them with all the information they need to safely take carvedilol. Additionally, patients should fully read any warning labels posted on their medication, and take care to follow their instructions.

Storage

Carvedilol should be stored at room temperature away from heat or moisture. Patients should follow the directions posted on their medications to determine how long they can store their carvedilol for without it losing it's potency or breaking down.

Summary

Carvedilol is a powerful drug that, when taken in concert with other effective drugs, can prolong and protect a patient's life. However, its' mechanism of action, which is to just block the effects of some agents in the body, can lead to a whole host of different side effects. Patients considering taking carvedilol should weigh the risks and benefits carefully before making a decision on whether or not to take the drug. Patients should always remember that drugs are meant to help, not hurt.

If a patient finds themselves forced into taking carvedilol, he or she can take solace in the fact that the potentially debilitating side effects are just part of the drugs strong, protective mechanism.