Carvedilol
COREG
What it isBeta-1, beta-2 and alpha-1 antagonist; systolic heart failure and hypertension.
Why this oneCombined beta and alpha-1 blockade gives heart-failure survival benefit plus vasodilation, but more orthostasis than beta-1-selective agents.
What limits itTake with food to limit orthostasis. Bradycardia and hypotension limit it; nonselective beta blockade can provoke bronchospasm.
FDA-approved for
- heart failure (1997)
- hypertension (1995)
Off-label
- arrhythmias
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Heart failure | Adults | 3.125 mg BID | up to 25 mg BID (50 mg BID if >85 kg) | 50 mg BID (>85 kg) |
| LV dysfunction after MI | Adults | 6.25 mg BID (3.125 mg BID if needed) | 25 mg BID | |
| Hypertension | Adults | 6.25 mg BID | 12.5–25 mg BID | 50 mg/day |
Titration Heart failure: increase at intervals ≥2 weeks; post-MI: after 3–10 days; hypertension: over 7–14 days per step
Renal Undefined
Hepatic Contraindicated in severe hepatic impairment
Instructions
- Take with food (slows absorption, reduces orthostatic effects)
- Do not discontinue abruptly — taper over 1–2 weeks
Contraindications
- Bronchial asthma or related bronchospastic conditions
- Second- or third-degree AV block
- Sick sinus syndrome
- Severe bradycardia (unless permanent pacemaker in place)
- Cardiogenic shock or decompensated heart failure requiring IV inotropes
- Severe hepatic impairment
Cautions
- Do not stop abruptly (angina/MI/arrhythmia risk)
- Bradycardia
- Hypotension/postural hypotension
- Worsening heart failure/fluid retention during up-titration
- Non-allergic bronchospasm
- May mask hypoglycemia / worsen hyperglycemia in diabetes
- Peripheral vascular disease aggravation
- Renal function deterioration in HF
- Intraoperative floppy iris syndrome (cataract surgery)
- Pheochromocytoma (start alpha-blocker first)
Adverse reactions
- Dizziness
- Fatigue
- Hypotension
- Bradycardia
- Diarrhea
- Hyperglycemia
- Asthenia
- Weight increase
Pregnancy Insufficient data; third-trimester beta-blocker use may cause neonatal hypotension, bradycardia, hypoglycemia, respiratory depression
Lactation No human data; present in rat milk — weigh benefits vs. risk
NO BOXED WARNINGS
Principal riskBradycardia and orthostatic hypotension
Cost, est. cash$10–$300/month
Generic entry2017
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityBradycardia, hypotension and worsening heart failure during titration; overdose can cause shock.
Mechanism of action: Carvedilol ballicule
Open Carvedilol in the interactive console ↗
Memory aids: mascots and interaction avatars
Polka dots on pink → α1 blocker → syncope if titrated too quickly (hit the floor)
LOL hat → β blocker
