carvedilol, Coreg (cont.)
Rifampin (Rifadin) can sharply decrease the carvedilol blood level. Therefore, in patients taking rifampin, the dose of carvedilol may need to be increased.
Carvedilol shares a common pathway for elimination by the liver with several other drugs such as quinidine (Quinaglute), fluoxetine (Prozac), paroxetine (Paxil), or propafenone (Rythmol). Use of these drugs may block the elimination of carvedilol. No studies have been done to confirm these effects on the elimination of carvedilol; however, carvedilol blood levels may be increased (along with the risk for carvedilol's side effects) if patients are taking any of these drugs.
Carvedilol may increase the levels in the blood of cyclosporin (Sandimmune, Neoral), and the dose cyclosporin may need to be adjusted when the two drugs are used together.
Amiodarone (Cordarone) may increase carvedilol levels in the blood, increasing the effects and potential for toxicity of carvedilol.
PREGNANCY: Safe use of carvedilol during pregnancy has not been established.
NURSING MOTHERS: No studies with carvedilol are available in nursing mothers; however, use is not recommended due to the risk of a slow heart rate in the infant.
SIDE EFFECTS AND PRECAUTIONS: The most common side effects of carvedilol are dizziness, edema (fluid accumulation), decreased heart rate, diarrhea and postural hypotension (a rapid decrease in blood pressure when going from the seated to the standing position that causes lightheadedness and/or fainting). Taking carvedilol with food minimizes the risk of postural hypotension.Other common side effects of carvedilol are irregular heart rhythm, and abnormalities of vision.
Carvedilol should be used cautiously in patients who use diuretics or who are elderly or have cirrhosis, asthma, peripheral vascular disease, hyperthyroidism, Prinzmetal's variant angina (angina at rest), and kidney disease.
Reference: FDA Prescribing Information
Last Editorial Review: 1/6/2009
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