Carvedilol
Trade name: Coreg, Dilatrend.
Class: antihypertensive, beta
blockers. Pregnancy:
(Category C)
Action:
• Blocks stimulation of beta1 (myocardial) and beta2 (pulmonary,
vascular, and uterine) -adrenergic receptor sites
• Also has alpha1 blocking activity, which may result in
orthostatic hypotension.
Uses:
• Management of hypertension.
• Management of CHF (due to ischemia or cardiomyopathy) with
digoxin, diuretics, and ACE inhibitors.
Dose
Hypertension, initially 12.5 mg once daily, increased
after 2 days to usual dose of 25 mg once
daily; if necessary may be further increased at
intervals of at least 2 weeks to max. 50 mg daily in single or divided
doses; ELDERLY initial dose of 12.5
mg daily may provide satisfactory control Angina,
initially 12.5 mg twice daily, increased after 2 days to 25 mg twice daily
Adjunct
in heart failure initially 3.125 mg twice daily (with food), dose
increased at intervals of at least 2 weeks to 6.25 mg twice daily, then to 12.5
mg twice daily, then to 25 mg twice daily; increase to highest dose tolerated,
max. 25 mg twice daily in patients with severe heart
failure or body-weight less than 85 kg and 50 mg twice daily in patients
over 85 kg
Contraindications:
§ Uncompensated CHF.
§ Pulmonary edema.
§ Cardiogenic shock.
§ Bradycardia or heart block.
§ Severe hepatic impairment or bronchial asthma/bronchospasm.
Side effects:
§ Carvedilol may cause hyperglycemia, tiredness, weakness,
lightheadedness, dizziness, headache,
§ diarrhea, nausea, vomiting, vision changes, joint pain,
difficulty falling asleep or staying asleep
§ Cough, dry eyes, numbness, burning, or tingling in the arms or
legs Nursing
considerations:
• Teach patient and family how to check pulse and blood pressure.
• May cause drowsiness or dizziness. Caution patients to avoid
driving or other activities that require alertness until response to the drug
is known.
• Patients with diabetes should closely monitor blood sugar
• Advise patient to notify health care professional if slow pulse,
difficulty breathing, wheezing, cold hands and feet, dizziness, confusion,
depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
• Hypertension: Reinforce the need to continue additional
therapies for hypertension (weight loss, sodium restriction, stress reduction,
regular exercise, moderation of alcohol consumption, and smoking cessation).
