Carvedilol

Brand names

• Coreg
• Dilatrend
• Eucardic
• Proreg

Usage

To treat mild to moderate congestive heart failure (CHF) in conjunction with diuretics and ACE inhibitors, with or without digoxin.

How it works

It is not known how carvedilol improves CHF. It causes blood vessels to dilate, which decreases blood pressure.

Side effects

Serious

Shortness of breath, wheezing; irregular or slow heartbeat (50 beats per minute or less); pain or feelings of tightness or pressure in the chest; swelling of the ankles, feet, and lower legs; mental depression. Seek medical help immediately.

Common

Dizziness or lightheadedness, especially when rising suddenly to a standing position; decreased sexual ability; unusual fatigue, weakness, or drowsiness; insomnia; diarrhea; nausea or vomiting.

Less common

Anxiety, irritability, nervousness; constipation; dry, sore eyes; itching; nightmares or intensely vivid dreams; swelling in legs; numbness, tingling, or other unusual sensations in the fingers, toes, or scalp.

Possible interactions

Other medicaments:

Carvedilol may increase the effects of:

• cyclosporine (Sandimmune, others) requiring cyclosporine dose decreases.
• other antihypertensive medicaments, and cause excessive lowering of the blood pressure. Dosage adjustments maybe necessary.
• reserpine (Ser-Ap-Es, etc.), and cause sedation, depression, slowing of the heart rate, and low blood pressure. This combination is best avoided.
• verapamil (Calan, Isoptin), and cause excessive depression of heart function; monitor this combination closely.

Carvedilol taken concurrently with:



• amiodarone (Cordarone) may cause severe slowing of the heart and sinus arrest. Do not combine this agent.
• cimetidine (Tagamet) may lead to excessive levels of carvedilol and possible toxic effects.
• clonidine (Catapres) requires close monitoring for rebound high blood pressure if clonidine is stopped while carvedilol is still being taken. Severe rebound hypertension may occur.
• digoxin (Lanoxin) may lead to abnormal heart conduction.
• diltiazem (Cardizem) (like verapamil) may be very helpful in patients with normal heart function, but may result in AV conduction problems.
• epinephrine (Adrenalin, etc.) may cause sudden rise in blood pressure followed by slowing of the heart rate. Avoid this combination.
• insulin requires close monitoring to avoid hypoglycemia.
• nifedipine (dihydroperidine) may result in excessive lowering of the blood pressure.
• oral antidiabetic medicaments may cause prolonged recovery from hypoglycemia should it occur.
• rifabutin (Mycobutin) may reduce carvedilol's effectiveness.
• zileuton (Zyflo) may result in increased toxicity risk from carvedilol.

The following medicaments may decrease the effects of carvedilol:



• indomethacin (Indocin), and possibly other "aspirin substitutes" or NSAIDs, may impair carvedilol's antihypertensive effect.

Herbal medicines or minerals:

Ginseng may increase blood pressure, blunting the benefits of this medicine. Hawthorn, saw palmetto, ma huang, goldenseal, yohimbe and licorice may also cause increased blood pressure. Calcium and garlic may help lower blood pressure. Indian snakeroot has a German Commission E monograph indication for hypertension-talk to your doctor. Eleuthero root and ma huang should be avoided by people living with hypertension.
Ginger, vanadium and nettle may also change blood sugar. Talk to your doctor before combining any herbal medicine or mineral with carvedilol.

Alcohol:

Alcohol may exaggerate blood pressure lowering and also increase its mild sedative effect.

Tobacco smoking:

Nicotine may reduce benefits in treating high blood pressure.
High doses may worsen bronchial constriction caused by regular smoking.

Exposure to heat:

Caution is advised. Hot environments can lower the blood pressure and exaggerate the effects of this medicament.

Exposure to cold:

Caution is advised. The elderly should take precautions to prevent hypothermia.

Heavy exercise or exertion:

Avoid exertion that produces light-headedness, excessive fatigue, or muscle cramping.

Occurrence of unrelated illness:

Fever can lower blood pressure and require decreased doses.
Illnesses that cause nausea or vomiting may interrupt the regular dosage schedule. Ask your physician for guidance.

Discontinuation:

Do not stop this medicament suddenly. If possible, gradual reduction of dose over a period of 2 to 3 weeks is recommended.