What is Carvedilol Used For?

Key Takeaways

Carvedilol is a commonly prescribed beta-blocker used to treat heart failure and high blood pressure and manage heart problems in people who have had a heart attack.
Off-label uses of carvedilol include stable angina (chest pain induced by activity or emotion), heart rhythm abnormalities, and prophylaxis of bleeding from cirrhotic esophageal varices (enlarged veins in the esophagus in people with liver disease).

Carvedilol is a commonly prescribed medication used to treat heart failure, high blood pressure, and improve survival in people who have had a heart attack. Please continue reading to find out carvedilol uses, dosing, side effects, and risks.

Is carvedilol a beta blocker?

Yes, carvedilol belongs to a group of medications called beta-blockers that work by blocking the effect of naturally occurring hormones called adrenaline. Adrenaline and noradrenaline are responsible for the body’s “fight or flight response.”

When confronted with stressful situations or danger, there is a spike of adrenaline in the body that causes symptoms such as heart palpitations, anxiety, high blood pressure, sweating, and fast heart rate.

By blocking the effects of these hormones, carvedilol helps to relax blood vessels, slow heart rate, improve blood flow to the heart, and lower blood pressure. As a result, carvedilol helps to make it easier for the heart to pump blood.

Additionally, carvedilol has anti-inflammatory and antioxidant effects, which can benefit those with heart disease.

Why would someone take carvedilol?

Health care providers may ask someone to take carvedilol, alone or in combination with other medications, to treat high blood pressure and heart failure or to improve survival after a heart attack. (Learn the difference between a heart attack vs angina.)

Off-label uses of carvedilol include stable angina (chest pain), heart rhythm abnormalities such as atrial fibrillation and ventricular arrhythmias, and prophylaxis (prevention) of bleeding from cirrhotic esophageal varices (enlarged veins in the esophagus in people with liver disease).

Is 25 mg carvedilol too much?

The recommended starting dose of carvedilol to treat high blood pressure is 6.25 milligrams (mg) twice daily. This can be increased to 12.5 mg twice daily after 7-14 days and 25 mg twice after an additional 7-14 days, based on response and tolerability of side effects. The maximum dose is a total of 50 mg daily.

The recommended starting dose of carvedilol to treat heart failure is 3.125 mg twice daily for 2 weeks. This can be increased to 6.25 mg twice daily, 12.5 mg twice daily, and 25 mg twice at 2-week intervals if needed. The maximum dose that has been given to people with chronic heart failure is 50 mg twice daily.

The recommended starting dose of carvedilol for left ventricular dysfunction after a myocardial infarction (heart attack) is 6.25 mg twice daily. This can be increased to 12.5 mg twice daily after 3-10 days and then to a target dose of 25 mg twice daily.

Carvedilol is also available as extended-release capsules that can be taken once daily. The dosing conversion when switching from immediate-release carvedilol tablets to extended release capsules is as follows:

3.125 mg twice daily (6.25 mg daily) of the immediate-release formulation is equivalent to 10 mg once daily of the extended release form.
6.25 mg twice daily (12.5 mg daily) of the immediate release formulation is equivalent to 20 mg once daily of the extended release form.
12.5 mg twice daily (25 mg daily) of the immediate release formulation is equivalent to 40 mg once daily of the extended release form.
25 mg twice daily (50 mg daily) of the immediate release formulation is equivalent to 80 mg once daily of the extended release form.

The adjustment and initiation of the dose of carvedilol will depend on the severity of the disease and the physician's individual assessment. Therefore, on some occasions, it is possible to start with higher doses. Talk to your doctor about proper dosing.

What is the main side effect of carvedilol?

Common side effects of carvedilol include weakness, tiredness, dizziness, headache, insomnia, nausea, vomiting, diarrhea, cough, stuffy or runny nose, changes in vision, dry eyes, worsening of asthma, joint pain, and burning, numbness or tingling sensations in the arms and legs.

Talk to your doctor if these side effects are severe or if they do not go away in a few days once your body has gotten used to the medicine.

More serious side effects of carvedilol are listed below. Call your doctor immediately or seek emergency medical care if you develop:

Chest pain
Shortness of breath
Trouble breathing or swallowing
Fainting
Swelling of the arms, hands, lower legs, ankles, or feet
Fluid retention
Weight gain
Slow or irregular heartbeat
Skin rash, hives, itching (signs of a serious allergic reaction)
Swelling of the face, lips, tongue, or throat

Is carvedilol a high-risk medication?

Carvedilol is a generally safe medication when it is taken as prescribed by a healthcare provider. However, like most medications, it carries some risks:

Risks associated with stopping carvedilol

There is an increased risk of angina (chest pain), heart attack, and cardiac arrhythmias if carvedilol therapy is stopped suddenly. Your doctor will tell you how to reduce the dose slowly.

Bradycardia

People taking carvedilol can develop a slow heartbeat. Keep a log of your blood pressure and heart rate at home. Your doctor will lower your carvedilol dose if your heart rate falls below 55 beats per minute.

Hypotension

Hypotension (low blood pressure), postural hypotension (low blood pressure with changes in position), and fainting can occur in people taking carvedilol. This is most likely to happen when you first start taking the medication and after the dose is increased.

Your doctor will start you on a low dose of carvedilol and gradually increase the dose. Taking carvedilol with food can decrease this risk. Be careful while driving and doing other hazardous activities until you know how this medication affects you.

Worsening heart failure and fluid retention

Increasing the dose of carvedilol can lead to fluid retention, which can make heart failure worse. If this happens, your healthcare professional may add other medications, such as diuretics (water pills), temporarily lower the dose of carvedilol, or discontinue this drug.

Non-allergic bronchospasm

People with bronchospastic lung diseases such as asthma, COPD (chronic obstructive pulmonary disease), chronic bronchitis, and emphysema should not take beta blockers, including carvedilol. The smallest dose will be used if you have lung disease and your doctor prescribes carvedilol.

This drug may need to be discontinued if there is evidence of bronchospasm (tightening of the airways) with symptoms such as shortness of breath or difficulty breathing.

Glycemic control in people with type 2 diabetes

Carvedilol and other beta blockers can mask the symptoms of hypoglycemia (low blood sugar levels), specifically fast heart rate and tremor. People with diabetes who take insulin or oral diabetes medications should be aware of this possibility.

Moreover, in people with heart failure and diabetes, carvedilol can lead to worsening glycemic control (high blood sugar levels). Measure your blood sugar regularly and talk to your doctor about adjusting your diabetes medications while on carvedilol.

Other health conditions

Carvedilol can worsen symptoms of peripheral arterial disease.
It should be used with caution in people with reduced kidney function or kidney failure.
Beta blockers are associated with increased risks during major surgery done using general anesthesia.
Carvedilol and other similar drugs can mask the symptoms of thyrotoxicosis (very high levels of thyroid hormones), such as a fast heart rate.
People with a rare tumor called pheochromocytoma must be started on an alpha blocker before starting a beta blocker.
Non-selective beta blockers can provoke a type of angina (chest pain) called Prinzmetal angina.
Rarely, serious allergic reactions can occur after taking carvedilol, including anaphylaxis (throat closing).
Carvedilol may cause complications during cataract surgery.

What should I avoid while taking carvedilol?

Precautions before starting carvedilol

Tell your doctor if you have ever had an allergic reaction to carvedilol, any of the active or inactive ingredients in carvedilol formulations, other beta blockers, or any other medicines.
Give your doctor a full list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal medicines such as St. John’s wort. This will help avoid potentially dangerous drug interactions.
Tell your doctor if you have a history of breathing problems, lung disease, heart disease, sick sinus syndrome, heart block, a slow or irregular heartbeat, liver disease, kidney disease, circulation problems, low blood sugar, hyperthyroidism (overactive thyroid gland), Prinzmetal angina, pheochromocytoma, or serious allergic reactions.
Tell your doctor if you are pregnant or nursing an infant with breast milk.

Precautions while taking carvedilol

Read the prescription label carefully and take carvedilol exactly as your doctor prescribes. Swallow the carvedilol oral tablet and extended release capsule whole. Do not cut, crush, or chew it.
Do not stop taking carvedilol suddenly. Your doctor will tell you how to lower the dose gradually.
Do not start taking other drugs during carvedilol therapy without checking with your doctor.
If you miss a dose of carvedilol, take it as soon as you remember. But if it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take a double dose or extra medicine to make up for a missed dose.
Carvedilol can cause dizziness, lightheadedness, tiredness, and vision changes. Be careful while driving and operating machinery until you know how it affects you.
Get up slowly from a sitting or lying position to standing. Tell your doctor if you develop lightheadedness, dizziness, or fainting when changing positions.
Do not drink alcohol while on this medicine. Drinking alcohol can make adverse effects like dizziness worse.
Carvedilol can make hypoglycemia (low blood sugar levels) worse and mask some of its symptoms. Make sure you know how to recognize low blood sugar and what to do if it happens.
You may have more serious allergic reactions and a reduced response to epinephrine while taking carvedilol.
Tell your doctor if your eyes become dry and contact lenses are bothersome while on carvedilol.
Call your doctor immediately or call the National Poison Control Center at 1-800-222-1222 in case of an overdose of carvedilol.

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