What to Know About Coreg (Carvedilol)

A beta-blocking medication

In This Article

Man looking at a prescription pill bottle

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Coreg (carvedilol) is a medication commonly used to treat individuals with congestive heart failure and to lower the blood pressure of those with hypertension. Carvedilol is a beta blocker, meaning it stops certain hormones from working within the heart and blood vessels. Due to the chemical makeup of this medication, an emergency dose of carvedilol is given to those who have had a heart attack. This is meant to reduce the risk of fatal side effects and prevent further injury. Carvedilol, which is sold under the brand name Coreg, comes in tablet and capsule form. There is an extended-release version available, called Coreg CR, which is the more appropriate option for some conditions.

Uses

The two primary approved uses of carvedilol include slowing the progression of congestive heart failure and lowering blood pressure in those who have hypertension. Another approved use is a dosage administered immediately following a heart attack, or myocardial infarction.

This medication stops certain hormones from working in the heart, allowing the cardiovascular system to maintain a regular and balanced state. This balance decreases the overall strain on the heart.

The intensity with which carvedilol works is dependent on whether or not it is taken with a meal. Doctors may educate patients taking carvedilol to take their dose with food to decrease the risk of an unsafe drop in blood pressure, also called orthostatic hypotension. Carvedilol is typically out of the body seven to 10 hours after it is taken.

Off-Label Uses

An off-label use of carvedilol is for the treatment of migraines and vascular headaches. It is known that carvedilol acts on the hormone levels impacting the heart, but these hormone levels also play a role elsewhere in the body.

Decreasing these hormone levels impacts the flow of blood through blood vessels everywhere in the body. By decreasing the intensity of blood flow, especially near the head and brain, the frequency and intensity of migraines are lessened.

While the primary approved uses of carvedilol relate to the treatment of the heart, there are other heart conditions which carvedilol has off-label uses for. The use of carvedilol for these purposes has minimal supporting research. One of these off-label uses is for both chronic, or stable, chest pain and acute, or unstable, chest pain.

Other off-label uses of carvedilol include the treatment of an irregular heartbeat, also called atrial flutter or atrial fibrillation.

Minimal research has been done regarding the off-label use of carvedilol in children with congestive heart failure. Due to the limited amount of conclusive research, carvedilol is not recommended for use in children.

Before Taking

All patients should undergo a thorough examination and medical history before being prescribed any medication. A patient should inform their doctor of all their current medications, including vitamins, herbs, and supplements, along with their allergies and past experiences with medications.

Carvedilol is typically a first-line medication, as it is often tried first to treat cardiovascular conditions. For this reason, a medical history is a very important precursor to determining if you are a good fit to take carvedilol.

Be sure to inform your doctor if you have:

  • Any issues with blood flow
  • Diabetes
  • Pulmonary conditions such as asthma
  • Liver disease
  • Kidney disease
  • Low blood pressure
  • A thyroid condition

If your doctor is informed of any of these conditions during your medical history, further examination and testing will likely be needed. Examination may include blood tests to determine liver and kidney health. As with many medications, carvedilol should not be taken by individuals who have moderately or severely impaired liver or kidney function.

The results of these and other tests will determine if you are able to take carvedilol. There are no known differences between the brand-name and generic versions of carvedilol.

Precautions and Contraindications

Carvedilol is not recommended for:

  • Children
  • Women who are pregnant or breastfeeding
  • Individuals who have bronchial asthma
  • Patients with severe liver disease or congestive heart failure, which requires the use of intravenous therapy
  • Patients with a risk of anaphylactic reactions or any other sensitivities to beta blockers

For people with thyroid conditions, kidney or liver disease, and heart failure: Carvedilol can mask an increased heart rate in patients with thyroid conditions and should be used with caution. Patients who have kidney disease, liver disease or acute heart failure along with second- or third-degree AV blocks should not use carvedilol unless they have a pacemaker. Otherwise, carvedilol can cause excessive fluid retention and a buildup of the drug in the heart.

Patients taking beta blockers before surgery of any kind should exercise caution, as carvedilol can interact negatively with anesthesia causing heart failure in some cases.

Patients with psoriasis, depression, or myasthenia gravis can experience an increase in symptoms once taking beta blockers, including a spread of psoriasis, muscle weakness, and double vision. Patients with depression experience this due to the impact beta blockers have on the brain.

Older patients should take carvedilol with caution. The body’s ability to eliminate diminishes with age and carvedilol may not be absorbed properly, causing a buildup in the heart. Patients with hypertension should be monitored carefully when taking carvedilol, as this increases their chance of developing diabetes mellitus. Carvedilol is also known to cover up the presence of hypoglycemia, which is an important early sign of those developing diabetes.

Drugs which can have major negative interactions with carvedilol include:

  • Amifostine and ceritinib (chemotherapy drugs)
  • Apixaban and betrixaban (blood thinners)
  • Amiodarone and bretylium (heart medications)
  • Aspirin and lidocaine (pain relievers)
  • Cabergoline (dopamine promoter)
  • Clonidine (sedative)
  • Colchicine (anti-inflammatory)

There are other drug interactions to be aware of, making it important to consult your doctor regarding the medications you are currently taking.

Other Beta Blockers

Other beta blockers with similar effects as carvedilol include:

  • Acebutolol
  • Atenolol
  • Bisoprolol
  • Metoprolol
  • Nadolol
  • Nebivolol
  • Propanolol
  • Timolol

Dosage

While dosage is individualized based on the patient’s medical history, tolerance, and other medical conditions, the U.S. Food and Drug Administration (FDA) along with the manufacturer have developed standard doses to guide practice. Capsules and tablets of carvedilol come in doses of 3.125 milligrams (mg), 6.25 mg, 12.5 mg, and 25 mg.

The recommended starting dosage for patients with congestive heart failure is 3.125 milligrams twice daily for two weeks. This dosage may be increased depending on patient tolerance. Obese patients may receive a maximum dosage up to 50 mg twice daily.

Starting dosage for patients who recently experienced a heart attack is 6.25 mg twice daily for 10 days with dosage adjusted depending on patient tolerance.

The recommended dosage for patients with hypertension is 6.25 mg twice daily for seven to 14 days. Adjustments will be made as needed depending on patient tolerance.

All listed dosages are according to the drug manufacturer. Be sure to check your prescription and talk to your doctor to ensure you are taking the right dose for your situation.

How to Take and Store

Consult your doctor regarding whether or not to take carvedilol with a meal. Your doctor may recommend carvedilol is taken with a meal to decrease its effects in the case of congestive heart failure. Carvedilol should be taken with enough water to ensure the capsule or tablet is swallowed.

If you miss a dose, it is advisable to take the missed dose as soon after it should have been taken. However, if you miss a dose and it is already time for your next dose, skip the missed dose and continue on with your regular dosing schedule.

If double doses are taken, a patient may experience dizziness or faintness and should contact their doctor immediately.

Carvedilol should be stored below 30°C in a tight, light-resistant container preferably in a cool, dark place.

Capsules contain powdered medicine within the external covering. Individuals who have difficulty swallowing the capsule may be instructed by their doctor to open the capsule and sprinkle this powder over their food.

Side Effects

As with all medications, carvedilol may cause side effects. Your doctor will let you know what to expect, but always be sure to ask questions if you have them.

Common

Common side effects of carvedilol include:

  • Chest pain
  • Dizziness
  • Fainting
  • Swelling of legs
  • Pain
  • Difficulty breathing
  • Slowed heartbeat
  • Weight gain

Severe

Less common side effects include:

  • Weakness or tingling on one side of the body
  • Lower back or stomach pain
  • Numbness and tingling of the hands, feet, or lips
  • Rapid and shallow breathing
  • Pounding in the ears
  • Pounding and slow heartbeat
  • Seizures
  • Slurred speech
  • Temporary blindness

These side effects may indicate a more serious problem which should immediately be resolved by emergency care and notifying your doctor.

Warnings and Interactions

Carvedilol has a black box warning, which is placed by the FDA on medications with effects which are potentially severe.

This drug should not be stopped without first consulting your doctor. Stopping this drug without a doctor’s direction could result in any of the severe side effects listed, including an increase in symptoms which have gotten better since taking carvedilol. A doctor will provide direction for adjusting doses as needed and with close monitoring.

Carvedilol should not be mixed with cocaine, or sedatives, as these drugs can increase the effectiveness of carvedilol, causing increased heart rate, increased blood pressure, and an increased risk of both stroke and heart attack.

Do not take extended-release carvedilol within two hours of consuming alcohol, as this can impact the rate of absorption and cause an increase in cardiovascular symptoms.

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Article Sources

  • Drug record: carvedilol. National Institutes of Health. Published May 3, 2019.

  • Carvedilol - drug summary. Prescribers’ Digital Reference. Published January 2019.

  • GlaxoSmithKline. Coreg (Carvedilol) Prescribing Information. Published February 2005.