Names and pronunciation
(kar-ved′i-lole) Coreg, Coreg CR
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Individual generic drug information
Extracted information for carvedilol only.
(kar-ved′i-lole) Coreg, Coreg CR
Source page 243
Func. class.: Antihypertensive, alpha-/ beta-adrenergic blocker
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Do not confuse: carvedilol/captopril
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ACTION: A mixture of nonselective alpha-/beta-adrenergic blocking activity; decreases cardiac output, exercise- induced tachycardia, reflex orthostatic tachycardia; causes vasodilation, reduc- tion in peripheral vascular resistance
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USES: Essential hypertension alone or in combination with other antihy- pertensives, HF, LV dysfunction after MI, cardiomyopathy
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Unlabeled uses: Angina, pediatric patients, atrial fibrillation/flutter
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Extracted information for carvedilol only.
CONTRAINDICATIONS: Hyper- sensitivity, asthma, class IV decompensated cardiac failure, second- or third-degree heart block, cardiogenic shock, severe bra- dycardia, pulmonary edema, severe hepatic disease, sick sinus symptoms Precautions: Pregnancy, breastfeeding, children, geriatric patients, cardiac fail- ure, hepatic injury, peripheral vascular disease, anesthesia, major surgery, diabetes mellitus, thyrotoxicosis, emphy- sema, chronic bronchitis, renal disease, abrupt discontinuation
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SIDE EFFECTS CNS: Dizziness, fatigue, weakness, somnolence, insomnia, ataxia, drowsi- ness, memory loss, paresthesia, vertigo, depression CV: Bradycardia, postural hypotension, HF, pulmonary edema GI: Diarrhea, abdominal pain, constipa- tion, nausea, vomiting GU: Decreased libido, impotence INTEG: Rash, Stevens-Johnson syndrome, toxic epidermal necrolysis MISC: Pruritus, hyperglycemia, weight gain, anaphylaxis, angioedema, lupus-like syndrome RESP: Dyspnea, bronchospasm EENT: Blurred vision, floppy iris syndrome, dry eyes
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INTERACTIONS Increase: conduction disturbances— calcium channel blockers Increase: carvedilol level—CYP2D6 inhibitors (FLUoxetine, quiNIDine) Increase: bradycardia, hypotension— levodopa, MAOIs Increase: hypoglycemia—antidiabetic agents, monitor blood glucose level, dosage of antidiabetics may need to be decreased Increase: concentrations of digoxin, cycloSPORINE, CYP2D6 inhibitors (FLUoxetine, quiNIDine) Increase: toxicity of carvedilol— cimetidine, other antihypertensives, ni- trates, acute alcohol ingestion; monitor for toxicity Decrease: heart rate, B/P—cloNIDine; monitor B/P, pulse frequently Decrease: carvedilol levels—rifAMPin, NSAIDs, thyroid medications; monitor B/P Drug/Herb Increase: antihypertensive effect— hawthorn Decrease: antihypertensive effect— ephedra (ma huang) Drug/Lab Test Increase: blood glucose, BUN, potas- sium, triglycerides, uric acid, biliru- bin, cholesterol, creatinine, LFTs, ANA titer Decrease: sodium, HDL
Source pages 244, 245
Extracted information for carvedilol only.
DOSAGE AND ROUTES Hypertension • Adult: PO 6.25 mg bid × 7-14 days; may increase to 25 mg bid; max 50 mg/day; EXTENDED RELEASE capsule 20 mg/day, may double after 7-14 days to 40 mg/day, max 80 mg/day Heart failure • Adult: PO 3.125 mg bid × 2 wk; may increase to give 6.25 mg bid × 2 wk, then double q2wk to max dose of 25 mg bid <85 kg or 50 mg bid >85 kg; EXTENDED RELEASE capsules (Coreg CR) 10 mg/day × 2 wk, increase to 20, 40, 80 mg/day over successive intervals of 2 wk Postmyocardial infarction Left ventricular dysfunction • Adult: PO 6.25 mg bid × 2 wk; titrate upward as tolerated q2wk; may increase to 12.5 mg bid, then titrate to 25 mg bid; PO EXTENDED RELEASE 20 mg daily; titrate upward after 3-10 days, increase to 40 mg daily; max 80 mg/day
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Available forms: Tablets 3.125, 6.25, 12.5, 25 mg; extended-release capsule 10, 20, 40, 80 mg
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Administer: • With food to minimize orthostatic hypotension; regular tablets may be crushed or swallowed whole; give ex- tended release every AM with food; do not break, crush, chew extended-re- lease capsule; separate alcohol (in- cluding OTC products that contain ethanol) by ≥2 hr; capsules may be opened and sprinkled over applesauce • Take apical pulse before use; notify prescriber if <50 bpm and hold dose • Conversion from immediate release to extended release: 3.125 mg bid is 10 mg daily; 6.25 mg bid is 20 mg daily; 12.5 mg bid is 40 mg daily; 25 mg bid is 80 mg daily • Do not discontinue before surgery
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Extracted information for carvedilol only.
Assess: • Hypertension: B/P when beginning treatment, periodically thereafter; pulse: note rate, rhythm, quality; apical/radial pulse before administration; in those with lower heart rate (<55 bpm) dose may need to be lowered; notify prescriber of significant changes; identify orthostatic hypotension when patient rises • Heart failure: edema in feet, legs daily; fluid overload: dyspnea, weight gain, jugular venous distention, fatigue, crackles, monitor I&O
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Evaluate: • Therapeutic response: decreased B/P with hypertension; decreased anginal pain
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To comply with dosage schedule even if feeling better; that improvement may take several weeks; not to crush, chew capsules; to take extended-release prod- uct with food • To rise slowly to sitting or standing po- sition to minimize orthostatic hypotension • To report slow pulse, dizziness, confu- sion, depression, fever, weight gain, SOB, cold extremities, rash, sore throat, bleed- ing, bruising • To weigh, take pulse, B/P at home; to advise if weight gain of >2 lb/day or 5 lb/ wk and when to notify prescriber • Not to discontinue product abruptly; to taper over 1-2 wk; life-threatening dys- rhythmias may occur • To avoid hazardous activities until sta- bilized on medication; dizziness may oc- cur • To carry emergency ID with product name, prescriber information at all times C • To inform all health care providers of products, supplements taken; to avoid all OTC medications unless approved by prescriber • That product may mask hypoglycemia, thyroid symptoms • Pregnancy/breastfeeding: to notify provider if pregnancy is planned or sus- pected; to avoid breastfeeding
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Extracted information for carvedilol only.
PHARMACOKINETICS Peak 1-2 hr; duration 7-9 hr; extended release onset 30 min, peak 5 hr, readily and extensively absorbed PO; >98% protein binding; extensively metabolized (CYP2D6, CYP2C9) by liver; excreted through bile into feces; half-life 7-10 hr with increases in geriatric patients, hepatic disease; some individuals may be poor metabolizers
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Filter the extracted dose blocks for this individual drug.
Hypertension
• Adult: PO 6.25 mg bid × 7-14 days; may increase to 25 mg bid; max 50 mg/day; EXTENDED RELEASE capsule 20 mg/day, may double after 7-14 days to 40 mg/day, max 80 mg/day Heart failure
Candidate age grouping · source page 244
Hypertension
• Adult: PO 3.125 mg bid × 2 wk; may increase to give 6.25 mg bid × 2 wk, then double q2wk to max dose of 25 mg bid <85 kg or 50 mg bid >85 kg; EXTENDED RELEASE capsules (Coreg CR) 10 mg/day × 2 wk, increase to 20, 40, 80 mg/day over successive intervals of 2 wk Postmyocardial infarction Left ventricular dysfunction
Candidate age grouping · source page 244
Hypertension
• Adult: PO 6.25 mg bid × 2 wk; titrate upward as tolerated q2wk; may increase to 12.5 mg bid, then titrate to 25 mg bid; PO EXTENDED RELEASE 20 mg daily; titrate upward after 3-10 days, increase to 40 mg daily; max 80 mg/day
Candidate age grouping · source page 244