Carvedilol
COREG
Pronunciation: KAR-ve-dil-ol (koe-REG)
“Corey the Carver”
Polka dots on pink → α1 blocker → syncope if titrated too quickly (hit the floor)
LOL hat → β blocker
What it isBeta-1, beta-2 and alpha-1 antagonist; systolic heart failure and hypertension.
Why this oneCombined beta and alpha-1 blockade gives heart-failure survival benefit plus vasodilation, but more orthostasis than beta-1-selective agents.
What limits itTake with food to limit orthostasis. Bradycardia and hypotension limit it; nonselective beta blockade can provoke bronchospasm.
FDA-approved for
- heart failure (1997)
- hypertension (1995)
Off-label
- arrhythmias
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Heart failure | Adults | 3.125 mg BID | up to 25 mg BID (50 mg BID if >85 kg) | 50 mg BID (>85 kg) |
| LV dysfunction after MI | Adults | 6.25 mg BID (3.125 mg BID if needed) | 25 mg BID | |
| Hypertension | Adults | 6.25 mg BID | 12.5–25 mg BID | 50 mg/day |
Titration Heart failure: increase at intervals ≥2 weeks; post-MI: after 3–10 days; hypertension: over 7–14 days per step
Renal Undefined
Hepatic Contraindicated in severe hepatic impairment
Instructions
- Take with food (slows absorption, reduces orthostatic effects)
- Do not discontinue abruptly — taper over 1–2 weeks
Available strengths
- tab 3.125, 6.25, 12.5, 25 mg
- ER cap 10, 20, 40, 80 mg
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 inotropes
- Severe hepatic impairment
Cautions
- Do not stop abruptly (angina/MI/arrhythmia risk)
- Bradycardia
- Hypotension/postural hypotension
- Worsening heart failure/fluid retention during up-titration
- Non-allergic bronchospasm
- May mask hypoglycemia / worsen hyperglycemia in diabetes
- Peripheral vascular disease aggravation
- Renal function deterioration in HF
- Intraoperative floppy iris syndrome (cataract surgery)
- Pheochromocytoma (start alpha-blocker first)
Adverse reactions
- Dizziness
- Fatigue
- Hypotension
- Bradycardia
- Diarrhea
- Hyperglycemia
- Asthenia
- Weight increase
Pregnancy Insufficient data; third-trimester beta-blocker use may cause neonatal hypotension, bradycardia, hypoglycemia, respiratory depression
Lactation No human data; present in rat milk — weigh benefits vs. risk
Cost
Generic entry2017
NO BOXED WARNINGS
Principal riskBradycardia and orthostatic hypotension
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityBradycardia, hypotension and worsening heart failure during titration; overdose can cause shock.
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