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- What is carvedilol, and how does it work (mechanism of action)?
- What brand names are available for carvedilol?
- Is carvedilol available as a generic drug?
- Do I need a prescription for carvedilol?
- What are the side effects of carvedilol?
- What is the dosage for carvedilol?
- Which drugs or supplements interact with carvedilol?
- Is carvedilol safe to take if I'm pregnant or breastfeeding?
- What else should I know about carvedilol?
What is carvedilol, and how does it work (mechanism of action)?
Carvedilol is used for treating high blood pressure and congestive heart failure. It is related to labetalol (Normodyne, Trandate). Carvedilol blocks receptors of the adrenergic nervous system, the system of nerves in which adrenalin (epinephrine) is active. Nerves from the adrenergic system enter the heart and release an adrenergic chemical (norepinephrine) that attaches to receptors on the heart's muscle and stimulates the muscle to beat more rapidly and forcefully. By blocking the receptors, carvedilol reduces the heart's rate and force of contraction and thereby reduces the work of the heart. Carvedilol also blocks adrenergic receptors on arteries and causes the arteries to relax and the blood pressure to fall. The drop in blood pressure further reduces the work of the heart since it is easier to pump blood against a lower pressure. The FDA first approved carvedilol in 1995.
What are the side effects of carvedilol?
The most common side effects of carvedilol are:
- 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), or kidney disease.
Quick GuideHow to Lower Blood Pressure: Exercise Tips
What is the dosage for carvedilol?
Carvedilol tablets are usually given twice daily. For high blood pressure, the dose is 6.25 mg twice daily to a maximum of 25 mg twice daily.
For congestive heart failure, the dose is 3.25 mg twice daily to a maximum of 25 mg twice daily. A maximum dose of 50 mg twice daily has been used in persons weighing more than 85 kg (187 pounds).
Carvedilol should be taken with food to slow its absorption and reduce the occurrence of low blood pressure when rising from a sitting or sleeping position (orthostatic hypotension). Stopping and changing doses of carvedilol should be done under the direction of a physician since sudden changes in dose can result in serious cardiac complications such as arrhythmias.
The dose range for treating heart failure or high blood pressure with extended release capsules is 10 to 80 mg once daily.
Which drugs or supplements interact with carvedilol?
Carvedilol can mask early warning symptoms of low blood sugar (hypoglycemia) such as tremors and increased heart rate. (These symptoms are caused by activation of the adrenergic nervous system which is blocked by the carvedilol.) Therefore, patients with diabetes taking medications that lower blood sugar such as insulin or oral anti-diabetic medications may need to monitor their blood sugar more often.
Reserpine, monoamine oxidase inhibitors (phenelzine or isocarboxazid) and clonidine (Catapress), because they have similar mechanisms of action as carvedilol, may greatly accentuate the effects of carvedilol and cause a steep decline in blood pressure and/or heart rate. Close monitoring of blood pressure and heart rate may be needed.
Carvedilol may cause an increase in digoxin (Lanoxin) blood levels. Therefore, in patients receiving digoxin, the digoxin blood level should be monitored if carvedilol is started, adjusted or discontinued.
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.
Is carvedilol safe to take if I'm pregnant or breastfeeding?
Safe use of carvedilol during pregnancy has not been established.
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.
What else should I know about carvedilol?
How should I keep carvedilol stored?
Tablets should be stored at room temperature, 15 C and 30 C (59 F and 86 F).
Reference: FDA Prescribing Information
Quick GuideHow to Lower Blood Pressure: Exercise Tips
Carvedilol (Coreg, Coreg CR) drug prescribed to control high blood pressure in addition to a diuretic. Carvedilol also may be prescribed in addition with other drugs to manage mild to moderate congestive heart failure and heart disease for patients who have suffered a recent heart attack. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed prior to taking this medication.
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Angina SymptomsAngina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
Chest PainChest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Congestive Heart Failure (CHF) OverviewCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
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High Blood Pressure HypertensionHigh blood pressure is defined as a pressure of 140/90 mmHg or higher in the arteries. Genetic factors, high salt intake, and increased arterial stiffness cause high blood pressure. Dizziness, headache, nausea, and shortness of breath are just a few symptoms of high blood pressure. Untreated high blood pressure increases the risk of heart disease, kidney disease, atherosclerosis, eye damage, stroke, and increased risk of aneurysms. High blood pressure can be managed with weight loss, lifestyle changes, and medication.
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ParathyroidectomyParathyroidectomy is the removal of one or more of the parathyroid glands to treat hyperparathyroidism. Risks of parathyroidectomy include:
- paralysis of the vocal cords,
- difficulty swallowing thin liquids,
- difficulty breathing,
- and drug reactions.
- damage to the recurrent laryngeal nerve,
- bleeding or hematoma,
- problems maintaining calcium levels in the blood,
- need for further and more aggressive surgery,
- need for a limited or total thyroidectomy,
- prolonged pain,
- impaired healing,
- and recurrence of the tumor.