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Coreg
carvedilol
Adult Dosing .
Dosage forms: TAB: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg
HTN
- [6.25-25 mg PO bid]
- Start: 6.25 mg PO bid, may double dose q1-2wk; Max: 50 mg/day; Info: give with food; taper dose over 1-2wk to D/C
heart failure with reduced ejection fraction
- [25-50 mg PO bid]
- Start: 3.125 mg PO bid, may double dose q2wk; Max: 50 mg/day; 100 mg/day if >85 kg; Info: minimize fluid retention prior to tx; give with food; taper dose over 1-2wk to D/C
left ventricular dysfunction, post-MI
- [25 mg PO bid]
- Start: 6.25 mg PO bid ASAP after patient stable, then double dose q3-10 days; Info: minimize fluid retention prior to tx; start 3.125 mg PO bid and/or titrate slower if fluid retention, hypotension, or bradycardia; give with food; taper dose over 1-2wk to D/C
atrial fibrillation/flutter (off-label)
- [3.125-25 mg PO bid]
- Alt: 3.125-50 mg PO bid; Info: for maintenance rate control; give with food; taper dose over 1-2wk to D/C
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: avoid use
Peds Dosing .
- Dosage forms: TAB: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg
heart failure with reduced ejection fraction (off-label)
- [1-23 mo]
- Dose: 0.2-3 mg/kg/day PO divided bid-tid; Start: 0.05 mg/kg/day divided bid-tid, may incr. dose q2wk; Max: 3 mg/kg/day; Info: minimize fluid retention prior to tx; give with food; taper dose over 1-2wk to D/C
- [2-11 yo]
- Dose: 0.2-2 mg/kg/day PO divided bid; Start: 0.05 mg/kg/day divided bid, may incr. dose q2wk; Max: 2 mg/kg/day; Info: minimize fluid retention prior to tx; give with food; taper dose over 1-2wk to D/C
- [12 yo and older]
- Dose: 0.2-1 mg/kg/day PO divided bid; Start: 0.05 mg/kg/day divided bid, may incr. dose q2wk; Max: 50 mg/day; Info: minimize fluid retention prior to tx; give with food; taper dose over 1-2wk to D/C
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- bradycardia, severe
- AV block, 2nd-3rd degree
- heart failure, decompensated
- cardiogenic shock
- sick sinus syndrome (patients without pacemaker)
- bronchial asthma
- hepatic impairment
- abrupt withdrawal
- caution: hypersensitivity to tartrazine (some generic forms)
- caution: PVD
- caution: Prinzmetal angina
- caution: bronchospastic disease
- caution: surgery, major
- caution: diabetes mellitus
- caution: fasting
- caution: thyroid disorder
- caution: WPW syndrome
- caution: pheochromocytoma
- caution: renal impairment
- caution: myasthenia gravis
- caution: anaphylactic reaction history, severe
- caution: CYP2D6 poor metabolizers
- caution: elderly patients
Drug Interactions .
Overview
carvedilol
beta blocker
- CYP2C9 substrate
- CYP2D6 substrate
- P-gp substrate
- P-gp inhibitor, moderate
- antihypertensive agent
- binds to cation exchange resin/polymer
- bradycardia
- delays atrioventricular conduction
- hyperglycemic effects
- hypoglycemic effects
Contraindicated
- colchicine
- isocarboxazid
Avoid/Use Alternative
- acebutolol
- albuterol
- albuterol inhaled
- aldesleukin
- apixaban
- arformoterol inhaled
- aripiprazole lauroxil
- atenolol
- betaxolol
- bisoprolol
- brigatinib
- carvedilol
- ceritinib
- clonidine
- crizotinib
- dabigatran
- doxorubicin
- ensartinib
- epinephrine
- esmolol
- etrasimod
- fenoldopam
- fexinidazole
- fingolimod
- formoterol inhaled
- labetalol
- landiolol
- lenacapavir
- levalbuterol inhaled
- lofexidine
- metoprolol
- nadolol
- nebivolol
- neratinib
- olodaterol inhaled
- ozanimod
- pindolol
- ponesimod
- pralsetinib
- propranolol
- relugolix
- repotrectinib
- rivaroxaban
- rivastigmine
- salmeterol inhaled
- siponimod
- sirolimus albumin-bound
- sotalol
- talazoparib
- terbutaline
- timolol
- topotecan
- venetoclax
- vilanterol inhaled
Monitor/Modify Tx
- abiraterone acetate
- acarbose
- adagrasib
- adenosine
- afatinib
- alectinib
- alfentanil
- alfuzosin
- almotriptan
- alogliptin
- alprostadil intracavernous
- amantadine
- amifostine
- amiodarone
- amitriptyline
- amoxapine
- amphetamine
- apalutamide
- apomorphine
- apraclonidine ophthalmic
- aripiprazole bimonthly injection
- aripiprazole monthly injection
- aripiprazole oral
- armodafinil
- arsenic trioxide
- articaine
- asciminib
- asenapine
- aspirin
- atazanavir
- atogepant
- atomoxetine
- atorvastatin
- atropine ophthalmic
- avanafil
- avatrombopag
- axitinib
- azithromycin
- belumosudil
- benzphetamine
- berberine
- betamethasone
- betaxolol ophthalmic
- bethanechol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bortezomib
- brexpiprazole
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- budesonide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- butorphanol
- cabergoline
- cabozantinib
- caffeine
- caffeine citrate
- canagliflozin
- cannabidiol
- cannabis
- carbamazepine
- carfilzomib
- cariprazine
- carteolol ophthalmic
- celecoxib
- chloroprocaine
- chlorpromazine
- cilostazol
- cinacalcet
- clarithromycin
- clofarabine
- clomipramine
- clozapine
- cobicistat
- cocaine
- codeine
- coenzyme Q-10
- colesevelam
- copanlisib
- corticotropin
- cortisone
- cyclosporine
- dacomitinib
- danazol
- danicopan
- danshen
- dapagliflozin
- darbepoetin alfa
- darunavir
- deflazacort
- denileukin diftitox
- desflurane
- desipramine
- desmopressin
- desvenlafaxine
- dexamethasone
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- diazoxide
- diclofenac
- diclofenac topical
- dicloxacillin
- diethylpropion
- diflunisal
- digoxin
- dihydrocodeine
- dihydroergotamine
- diltiazem
- dinutuximab
- diosmin
- dipyridamole
- disopyramide
- dobutamine
- donepezil
- dopamine
- doxapram
- doxazosin
- doxepin
- dronabinol
- dronedarone
- droxidopa
- dulaglutide
- duloxetine
- edoxaban
- efavirenz
- eletriptan
- eliglustat
- empagliflozin
- enfortumab vedotin
- entacapone
- entrectinib
- enzalutamide
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine inhaled
- epoetin alfa
- epoprostenol
- eptinezumab
- erenumab
- ergotamine
- ertugliflozin
- erythromycin
- esketamine
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethanol (alcoholic beverage)
- ethanol injection
- ethinyl estradiol (contraceptive)
- etodolac
- everolimus
- exenatide
- fenfluramine
- fenoprofen
- fentanyl
- ferumoxytol
- flaxseed
- flecainide
- flibanserin
- fluconazole
- fludrocortisone
- fluorouracil
- fluoxetine
- fluphenazine
- flurbiprofen
- foslevodopa
- fosphenytoin
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- gadobenate dimeglumine
- galantamine
- galcanezumab
- garlic
- gilteritinib
- glecaprevir
- glimepiride
- glipizide
- glyburide
- guanfacine
- haloperidol
- hoodia
- hydralazine
- hydrocodone
- hydrocortisone
- hydromorphone
- hydroxocobalamin IV
- ibrutinib
- ibuprofen
- iloperidone
- iloprost
- imipramine
- indomethacin
- insulin
- iron sucrose
- isoflurane
- isoproterenol
- isosorbide dinitrate
- isosorbide mononitrate
- itraconazole
- ivabradine
- ketamine
- ketoconazole
- ketoprofen
- ketorolac
- lacosamide
- lamotrigine
- lanreotide
- lapatinib
- ledipasvir
- lefamulin
- leflunomide
- lenvatinib
- levobunolol ophthalmic
- levodopa
- levoketoconazole
- levomilnacipran
- levorphanol
- levothyroxine
- licorice
- lidocaine
- linagliptin
- liothyronine
- liraglutide
- lisdexamfetamine
- lixisenatide
- lopinavir/ritonavir
- lorlatinib
- lovastatin
- loxapine
- lubiprostone
- lumacaftor/ivacaftor
- lumateperone
- lurasidone
- luspatercept
- magnesium salicylate
- magnesium sulfate
- maraviroc
- mavacamten
- mavorixafor
- meclofenamate
- mefenamic acid
- mefloquine
- meloxicam
- meperidine
- mepivacaine
- meropenem
- methadone
- methamphetamine
- methohexital
- methoxy polyethylene glycol-epoetin beta
- methylene blue injection
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- midazolam
- midodrine
- miglitol
- milk thistle
- milnacipran
- milrinone
- milsaperidone
- mirabegron
- mirtazapine
- modafinil
- molindone
- morphine
- nabumetone
- nalbuphine
- naphazoline ophthalmic
- naproxen
- naratriptan
- nateglinide
- nattokinase
- naxitamab
- neostigmine
- niacin (vitamin B3)
- niraparib
- nitisinone
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- obinutuzumab
- octreotide
- olanzapine
- oliceridine
- opicapone
- opium
- osilodrostat
- oxaprozin
- oxazepam
- oxcarbazepine
- oxycodone
- oxymetazoline nasal
- oxymetazoline ophthalmic
- oxymetazoline topical
- oxymorphone
- oxytocin
- paliperidone
- palopegteriparatide
- paltusotine
- paroxetine
- pasireotide
- patiromer
- pazopanib
- pentamidine
- pentazocine
- pentobarbital
- pentoxifylline
- perphenazine
- pexidartinib
- phendimetrazine
- phenelzine
- phenobarbital
- phentermine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- phenytoin
- pibrentasvir
- pioglitazone
- piroxicam
- pitavastatin
- ponatinib
- pramipexole
- pramlintide
- praziquantel
- prazosin
- prednisolone
- prednisone
- primidone
- procainamide
- procarbazine
- prochlorperazine
- promethazine
- propafenone
- propofol
- protriptyline
- pseudoephedrine
- pyridostigmine
- quetiapine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- ramucirumab
- ranolazine
- rasagiline
- red yeast rice
- regadenoson
- regorafenib
- remifentanil
- remimazolam
- repaglinide
- rifabutin
- rifampin
- rifapentine
- rimegepant
- riociguat
- ripretinib
- risperidone
- ritonavir
- rizatriptan
- ropinirole
- ropivacaine
- rosiglitazone
- rotigotine transdermal
- sacubitril
- safinamide
- salsalate
- saxagliptin
- selegiline
- selegiline transdermal
- selpercatinib
- semaglutide
- sevoflurane
- sildenafil
- silodosin
- simvastatin
- sirolimus
- sitagliptin
- sodium ferric gluconate complex
- sorafenib
- sotagliflozin
- sotorasib
- sparsentan
- St. John's wort
- succinylcholine
- sufentanil
- sugammadex
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- tenofovir alafenamide
- tenofovir disoproxil
- tepotinib
- terazosin
- terbinafine
- teriflunomide
- testosterone
- tetrahydrozoline ophthalmic
- thalidomide
- thioridazine
- thiothixene
- thyroid
- ticagrelor
- timolol ophthalmic
- tipranavir
- tirzepatide
- tivozanib
- tizanidine
- tolcapone
- tolmetin
- tramadol
- trametinib
- tranylcypromine
- trazodone
- treprostinil
- triamcinolone
- trifluoperazine
- trimipramine
- tucatinib
- turmeric
- ubrogepant
- vaborbactam
- vadadustat
- vamorolone
- vandetanib
- vardenafil
- vasopressin
- vemurafenib
- venlafaxine
- verapamil
- viloxazine
- vimseltinib
- voclosporin
- vosoritide
- voxilaprevir
- yohimbe
- zavegepant
- ziprasidone
- ziv-aflibercept
- zolmitriptan
Caution Advised
- aliskiren
- cevimeline
- darolutamide
- methacholine inhaled
- naldemedine
- pilocarpine
- tasimelteon
Adverse Reactions .
Serious Reactions
- CHF
- bradycardia, severe
- heart block
- angina exacerbation
- angina exacerbation if abrupt D/C
- MI if abrupt D/C
- ventricular arrhythmia if abrupt D/C
- asthma
- bronchospasm
- hypersensitivity reaction
- anaphylactoid reaction
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- erythema multiforme
- exfoliative dermatitis
- photosensitivity
- lupus erythematosus
- pneumonitis, interstitial
- leukopenia
- thrombocytopenia
- anemia
- aplastic anemia
- intraoperative floppy iris syndrome
Common Reactions
- dizziness
- fatigue
- diarrhea
- hyperglycemia
- weight gain
- hypotension
- bradycardia
- dyspnea
- nausea
- headache
- asthenia
- vomiting
- arthralgia
- BUN elevated
- visual disturbance
- edema
- hypercholesterolemia
- rales
- syncope
- angina
- anemia
- pulmonary edema
- ALT or AST elevated
Safety/Monitoring .
Monitoring Parameters
BUN/Cr with dose incr. if renal impairment risk; in diabetes patients, glucose at tx start, dose change, and D/C; BP, HR
Look/Sound-Alike Drug Names
Coreg confused with: Corgard; Cortef; Cortone Acetate; Cozaar
carvedilol confused with: atenolol; captopril; carbidopa; carteolol
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, especially in 2nd and 3rd trimesters; inadequate human data available, though possible risk of intrauterine growth restriction; no known risk of teratogenicity, though possible risk of neonatal adverse effects, including bradycardia and hypoglycemia, based on limited human data with other beta blockers
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: for carvedilol: liver extensively; CYP450:1A2, 2C9/19, 2D6 (primary), 2E1, 3A4 substrate
Excretion: for carvedilol: feces 60%, urine 16% (<2% unchanged); Half-life: 6-10h
Subclass: Antiarrhythmics, Oral ; Beta Blockers
Mechanism of Action
for carvedilol: selectively antagonizes alpha-1 adrenergic receptors; antagonizes beta-1 and beta-2 adrenergic receptors (selective alpha and non-selective beta blocker)
Formulary .
No Formulary Selected
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