CARVEDILOL

Indications & Dose:

Hypertension

• BY MOUTH

Adult: Initially 12.5 mg once daily for 2 days, then increased to 25 mg once daily; increased if necessary up to 50 mg daily, dose to be increased at intervals of at least 2 weeks and can be given as a single dose or in divided doses

Elderly: Initially 12.5 mg daily, initial dose may provide satisfactory control

Angina

• BY MOUTH

Adult: Initially 12.5 mg twice daily for 2 days, then increased to 25 mg twice daily

Adjunct to diuretics, digoxin, or ACE inhibitors in symptomatic chronic heart failure  

• BY MOUTH

Adult: Initially 3.125 mg twice daily, dose to be taken with food, then increased to 6.25 mg twice daily, then increased to 12.5 mg twice daily, then increased to 25 mg twice daily, dose should be increased at intervals of at least 2 weeks up to the highest tolerated dose, max. 25 mg twice daily in patients with severe heart failure or body-weight less than 85 kg;

Contraindications:

Bronchial  asthma,cardiogenic shock, overt cardiac failure, second and third degree AV block, severe sinus bradycardia

Side Effects:

CNS: Dizziness

CV: AV block, bradycardia (2%), CHF, postural hypotension (1.8%), syncope (0.1 %)

GI: Elevated LFTs (1.1 %)

RASP: Bronchospasm

Cautions:

Precautions:

Anesthesia/surgery (myocardial depression),avoid abrupt withdrawal; bronchospastic airways, congestive heart failure;diabetes mellitus, hyperthyroidism/thyrotoxicosis,concurrent clonidine (discontinue several days prior to withdrawal of clonidine), peripheral vascular disease, renal disease.

Pregnancy, breast-feeding: & old age: Use with caution.

Interaction:

Drugs 

Alfa-1 adrenergic blockers: Potential enhanced first dose response (marked initial drop in blood pressure, particularly on standing)

Amiodarane: Symptomatic bradycardia and sinus arrest; AV node refractory period prolonged and sinus node automaticity decreased, especially patients with bradycardia, sick sinus syndrome, or partial AV

Benzodiazepines: Increased benzodiazepine activity

Cimetidine: Via inhibition of hepatic metabolism, cimetidine increases many ß-blocker serum concentrations

Clonidine: Withdrawal of clonidine abruptly may exaggerate the hypertension due to unopposed alpha- stimulation; safer than other beta-blockers, however

Digoxin: Additive prolongation of atrioventricular (AV) conduction time

Dihydropyridine calcium channel blockers: Severe hypotension or impaired cardiac performance; most prevalent with impaired left ventricular function,cardiac arrhythmias, or aortic stenosis

Diltiazem: Potentiates beta-adrenergic effects; hypotension, left ventricular failure, and AVconduction disturbances problematic in elderly,patients with left ventricular dysfunction, aortic stenosis, or with large doses of either drug

Hypoglycemic agents: Masked hypoglycemia,hyperglycemia

Nonsteroidal antiinflammatory drugs: Reduced antihypertensive effect

Rifampin: 70% decrease in carvedilol concentrations

Verapamil: Potentiates beta-adrenergic effects; hypotension, left veconduction disturbances problematic in elderly, patients with left ventricular dysfunction, aortic stenos is, or with large doses of either drug

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: