| name | Carvedilol |
| classification | Beta-blocker, Non-selective alpha and beta-adrenergic blocking agent |
| pharmacokinetics | Carvedilol is well absorbed after oral administration. Peak plasma concentrations are achieved within 1-2 hours. The drug undergoes extensive first-pass metabolism, with significant hepatic extraction. It is highly protein-bound (approximately 95%). Carvedilol's metabolism involves conjugation and oxidation. The drug is primarily excreted in the urine and feces, with the elimination half-life varying depending on the specific formulation. Renal and hepatic function can affect metabolism and excretion. |
| suggested dosage | | general | Dosage varies depending on the indication and patient response. It's essential to follow a physician's recommendations. Consult a doctor for proper dosage adjustments, especially in patients with hepatic or renal impairment. | | example hypertension | Initial dose: 6.25-12.5mg twice daily; titrated to 25-50 mg twice daily or as directed by the healthcare provider. Adjustments should be based on blood pressure response. | | patient specific considerations | Consider age, weight, kidney and liver function and overall health in the determination of dosage. | | weight 70kg example | Initial dosing for hypertension would be guided by the physician and likely start at 6.25mg twice daily, and gradually titrated up as tolerated. Close blood pressure monitoring is essential. |
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| indications | | 1 | Essential hypertension | | 2 | Heart failure (with reduced ejection fraction) | | 3 | Angina pectoris | | 4 | Post-myocardial infarction | | 5 | Hypertrophic obstructive cardiomyopathy |
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| safety in pregnancy | Carvedilol is generally not recommended for use during pregnancy. Its use should be carefully considered by the prescribing physician if the potential benefit outweighs the potential risks to the developing fetus, and should be utilized only under exceptional circumstances. The patient should be advised to immediately inform their doctor if pregnant or planning a pregnancy. |
| safety in breastfeeding | Carvedilol may pass into breast milk. The decision to use carvedilol during breastfeeding should be made carefully and after considering the benefits to the mother and risks to the infant. The prescribing physician should be consulted to weigh the pros and cons. |
| side effects | | 1 | Fatigue | | 2 | Dizziness | | 3 | Headache | | 4 | Bradycardia (slow heart rate) | | 5 | Hypotension (low blood pressure) | | 6 | Gastrointestinal upset (nausea, vomiting, diarrhea) | | 7 | Peripheral edema | | 8 | Weakness | | 9 | Cold extremities | | 10 | Dry eyes | | 11 | Sexual dysfunction |
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| alternatives | |
| contraindications | | 1 | Severe bradycardia | | 2 | Second or third-degree atrioventricular (AV) block (without a pacemaker) | | 3 | Severe hypotension | | 4 | Cardiogenic shock | | 5 | Bronchospastic disease (e.g., asthma) | | 6 | Severe peripheral artery disease | | 7 | Known hypersensitivity to carvedilol |
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| interactions | | 1 | Other beta-blockers | | 2 | Calcium channel blockers (especially verapamil and diltiazem) | | 3 | MAO inhibitors | | 4 | CYP2D6 inhibitors | | 5 | Insulin and oral hypoglycemic agents | | 6 | Nonsteroidal anti-inflammatory drugs (NSAIDs) | | 7 | Digoxin | | 8 | Alcohol |
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| warnings and precautions | | 1 | Patients with asthma or chronic obstructive pulmonary disease (COPD) should use caution. Gradual dose titration is important. | | 2 | Monitor blood pressure and heart rate carefully, especially during initiation or dose adjustment. | | 3 | Avoid abrupt discontinuation of therapy, as this can lead to rebound effects or exacerbation of underlying conditions. | | 4 | Monitor for signs of worsening heart failure. | | 5 | Caution is advised in patients with peripheral vascular disease or Raynaud's phenomenon. | | 6 | Carefully monitor blood sugar in patients with diabetes |
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| additional information | Carvedilol can mask the symptoms of hypoglycemia. Blood sugar levels should be closely monitored, particularly in patients with diabetes. The patient should also be advised to avoid sudden changes in posture to prevent orthostatic hypotension. |
| patient age | 25 years |
| patient weight | 70 kg |
