carvedilol

Drug Name

Generic Name : carvedilol

Brand Name: Coreg

Classification: Alpha- and beta-adrenergic blocker, Antihypertensive

Pregnancy Category C

Dosage & Route
Oral
  • hypertension
    • Adult: Initially, 12.5 mg once daily increased to 25 mg once daily after 2 days. Alternatively, initial dose of 6.25 mg bid increased to 12.5 mg bid after 1-2 wk, increased further if necessary to 50 mg once daily or in divided doses.
    • Elderly: 12.5 mg once daily.
  • Angina pectoris
    • Adult: Initially, 12.5 mg bid increased to 25 mg bid after 2 days.
  • heart failure
    • Adult: Initially, 3.125 mg bid, doubled to 6.25 mg bid after 2 wk if tolerated, then gradually increased to the max dose the patient can tolerate at intervals of not <2 wk. Max dose: >85 kg: 50 mg bid; <85 kg: 25 mg bid.
  • Left ventricular dysfunction post myocardial infarction
    • Adult: Initially: 6.25 mg bid, if tolerated, after 3-10 days, increase to 12.5 mg bid and then to a target dose of 25 mg bid.
Therapeutic actions
  • Carvedilol causes vasodilation by blocking the activity of α-blockers, mainly at alpha-1 receptors. It exerts antihypertensive effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM.
    • Absorption: Absorbed well from the GI tract (oral); peak plasma concentrations after 1-2 hr.
    • Distribution: Enters breast milk. Protein-binding: >98%.
    • Metabolism: Hepatic: Considerable first-pass effect.
    • Excretion: Via bile (as metabolites); 6-10 hr (elimination half-life).
Indications
  • 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)
Adverse effects
  • Bradycardia, AV block, angina pectoris, hypervolemia, leucopenia, hypotension, peripheral edema, allergy, malaise, fluid overload, melena, periodontitis, hyperuricemia, hyponatremia, increased alkaline phosphatase, glycosuria, prothrombin time, SGPT and SGOT levels, purpura, somnolence, impotence, albuminuria, hypokinesia, nervousness, sleep disorder, skin reaction, tinnitus, dry mouth, anemia, sweating, fatigue, arthralgia, aggravation, dizziness. Diarrhea, nausea, vomiting, insomnia, hypercholesterolemia, weight gain, abnormal vision, rhinitis, pharyngitis and hypertriglyceridemia.
Contraindications
  • Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Patients with NYHA class IV cardiac failure, 2nd or 3rd ° AV block, sick sinus syndrome (unless a permanent pacemaker is in place), cardiogenic shock or severe bradycardia. Lactation.
Nursing considerations
Assessment
  • 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, LFTs, renal and thyroid function tests, blood and urine glucose
Interventions
  • 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 diabetic patient closely; drug may mask hypoglycemia or worsen hyperglycemia.
  • WARNING: Monitor patient for any sign of hepatic impairment (pruritus, dark urine or stools, anorexia, jaundice, pain); arrange for LFTs and discontinue drug if tests indicate liver injury. Do not restart carvedilol.
Teaching points
  • Take drug with meals.
  • Do not stop taking drug unless instructed to do so by a health care provider.
  • Avoid use of over-the-counter medications.
  • Advise the diabetic patient to promptly report changes in glucose.
  • 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.