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carvedilol
Coreg, Eucardic§

Pregnancy Risk Category C

How supplied
Tablets:
3.125 mg, 6.25 mg, 12.5 mg, 25 mg

Action
Nonselective beta blocker with alpha1-blocking activity.

Indications & dosage
Hypertension--

Adults:
dosage highly individualized. Initially, 6.25 mg P.O. b.i.d. Obtain a standing blood pressure 1 hour after initial dose. If tolerated, continue dosage for 7 to 14 days. May increase to 12.5 mg P.O. b.i.d. for 7 to 14 days, following blood pressure monitoring protocol noted above. Maximum dose is 25 mg P.O. b.i.d. as tolerated.
Heart failure--

Adults:
dosage highly individualized. Initially, 3.125 mg P.O. b.i.d. for 2 weeks; if tolerated, can increase to 6.25 mg P.O. b.i.d. Dosage may be doubled q 2 weeks as tolerated. Maximum dose for patients under 85 kg (187 lb) is 25 mg P.O. b.i.d.; for those over 85 kg, dose is 50 mg P.O. b.i.d.
Adjust-a-dose:
If patient experiences bradycardia with pulse rate below 55 beats/minute, use reduced dosage.

Adverse reactions
CNS:
dizziness, fatigue, headache, hypoesthesia, insomnia, pain, paresthesia, somnolence, vertigo, syncope, malaise.
CV:
aggravated angina pectoris, AV block, bradycardia, chest pain, fluid overload, hypertension, hypotension, orthostatic hypotension, edema.
EENT:
abnormal vision, pharyngitis, rhinitis, sinusitis.
GI:
abdominal pain, diarrhea, melena, nausea, periodontitis, vomiting.
GU:
abnormal renal function, albuminuria, hematuria, impotence, urinary tract infection, elevated BUN levels.
Hematologic:
purpura, thrombocytopenia, decreased PT and INR.
Hepatic:
increased serum alkaline phosphatase, ALT, and AST levels.
Metabolic:
dehydration, glycosuria, gout, hypercholesterolemia, hyperglycemia, hypertriglyceridemia, hypervolemia, hypovolemia, hyperuricemia, hypoglycemia, hyponatremia, weight gain.
Musculoskeletal:
arthralgia, back pain, myalgia,
Respiratory:
bronchitis, dyspnea, upper respiratory tract infection.
Other:
allergy, fever, peripheral edema, sudden death, viral infection.

Interactions
Drug-drug.
Calcium channel blockers: can cause isolated conduction disturbances. Monitor patient's heart rhythm and blood pressure.
Catecholamine-depleting drugs, such as MAO inhibitors, reserpine:
may cause bradycardia or severe hypotension. Monitor patient closely.
Cimetidine:
increased bioavailability of carvedilol. Monitor vital signs carefully.
Clonidine:
may potentiate blood pressure and heart rate-lowering effects. Monitor vital signs closely.
Digoxin:
increased levels of digoxin by about 15% when given concurrently. Monitor digoxin levels.
Fluoxetine, quinidine, paroxetine, propafenone:
increased blood levels of carvedilol by inhibiting metabolism. Monitor vital signs closely.
Insulin, oral antidiabetics:
concomitant use may enhance hypoglycemic properties. Monitor blood glucose levels.
Rifampin:
reduced plasma levels of carvedilol by 70%. Monitor vital signs closely.
Drug-food.
Any food: delayed rate of absorption of carvedilol but does not alter extent of bioavailability. Advise patient to take drug with food to minimize orthostatic effects.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to drug and in those with New York Heart Association class IV decompensated cardiac failure requiring I.V. inotropic therapy. Also contraindicated in those with bronchial asthma or related bronchospastic conditions, second- or third-degree AV block, sick sinus syndrome (unless a permanent pacemaker is in place), cardiogenic shock, severe bradycardia, or symptomatic hepatic impairment.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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