Overview
Carvedilol is a non-selective beta-adrenergic blocker with alpha-1 blocking activity used primarily for hypertension, heart failure, and post-myocardial infarction. It reduces cardiac workload through vasodilation and negative chronotropic/inotropic effects. The medication should be taken with food to minimize orthostatic hypotension.
Mechanism of Action
Carvedilol is a non-selective beta-adrenergic blocker with alpha-1 adrenergic blocking activity. It reduces cardiac output through negative chronotropic and inotropic effects while causing peripheral vasodilation via alpha-1 blockade, decreasing systemic vascular resistance and myocardial oxygen demand.
Indications
- Hypertension
- Heart failure (NYHA Class II-IV) to reduce cardiovascular mortality
- Left ventricular dysfunction following myocardial infarction
Common Doses
- 3.125 mg
- 6.25 mg
- 12.5 mg
- 25 mg
Dosage
Take with food to slow absorption and reduce orthostatic effects. Titrate gradually based on clinical response and tolerability. For heart failure, start low (3.125 mg twice daily) and double dose every 2 weeks as tolerated.
Contraindications
- Bronchial asthma or related bronchospastic conditions
- Second- or third-degree AV block
- Sick sinus syndrome
- Severe bradycardia (unless permanent pacemaker in place)
- Cardiogenic shock or decompensated heart failure requiring IV inotropic therapy
- Severe hepatic impairment
- History of serious hypersensitivity reaction to carvedilol components
Side Effects
- Dizziness
- Fatigue
- Hypotension
- Bradycardia
- Edema
- Hyperglycemia
- Bronchospasm
- AV conduction abnormalities
- Rare: Stevens-Johnson syndrome, anaphylaxis, angioedema
Interactions
- CYP2D6 inhibitors (increase carvedilol levels)
- Other antihypertensives (additive hypotension)
- Insulin/oral hypoglycemics (masked hypoglycemia)
- Calcium channel blockers (increased bradycardia/AV block risk)
- Digoxin (increased levels)
Counseling Points
- Take with food to reduce dizziness
- Do not stop abruptly
- Monitor for signs of worsening heart failure
- Rise slowly from sitting/lying position
- Report difficulty breathing or swelling
- Carry medical alert identification