Carvedilol

Non-selective Beta-Blocker with Alpha-1 Blocking Activity

Generic Name

Carvedilol

Drug Class

Non-selective beta-adrenergic blocker with alpha-1 blocking activity

Indications

Hypertension
Heart failure (NYHA class II–IV)
Left ventricular dysfunction post-myocardial infarction
Angina pectoris

Dosage

Hypertension (adults): 6.25 mg orally twice daily initially; may titrate to 25 mg twice daily
Heart failure (adults): 3.125 mg orally twice daily initially; double dose every 2 weeks as tolerated to target 25 mg twice daily (for patients <85 kg) or 50 mg twice daily (>85 kg)
Post-MI: 6.25 mg orally twice daily; titrate to 12.5–25 mg twice daily
Children: Use under specialist guidance; dosing individualized

Note: Take with food to reduce risk of orthostatic hypotension. Adjust dose in hepatic impairment.

Route of Administration

Oral (tablet, extended-release capsule)

Mechanism of Action

Carvedilol blocks beta-1 and beta-2 adrenergic receptors, reducing heart rate, myocardial contractility, and blood pressure. Alpha-1 blockade causes vasodilation, further reducing systemic vascular resistance and blood pressure.

Common Adverse Effects

Dizziness or lightheadedness
Fatigue
Bradycardia
Diarrhea or nausea
Weight gain (in heart failure)

Serious Adverse Effects

Severe bradycardia or heart block
Hypotension
Exacerbation of heart failure
Bronchospasm (in asthma or COPD patients)

Contraindications

Asthma or severe COPD with bronchospasm
Second- or third-degree AV block
Severe bradycardia
Cardiogenic shock
Hypersensitivity to carvedilol

Precautions

Monitor heart rate, blood pressure, and signs of worsening heart failure
Use with caution in diabetes; may mask hypoglycemia
Taper gradually when discontinuing
Adjust dose in hepatic impairment

Drug Interactions

Other antihypertensives – additive hypotensive effect
Antiarrhythmics – increased risk of bradycardia
Insulin/oral hypoglycemics – hypoglycemia masking
CYP2D6 inhibitors – increased carvedilol levels

Pregnancy & Lactation

Use only if clearly needed; may cause fetal bradycardia or hypoglycemia. Excreted in breast milk – monitor infant.

Patient Counseling

Take with food
Do not stop abruptly
Monitor vitals regularly
Report dizziness or breathing difficulty