Indications
Coreg is used, often with other medicines to treat high blood pressure (hypertension), heart attack patients, certain types of heart failure, chronic heart failure and is used to reduce cardiovascular mortality in clinically stable patientswho have survived the acute phase of a myocardial infarction Coreg is additionally, indicated for the management of essential hypertension. It can be used alone or in combination with other antihypertensive agents, especially thiazide-type diuretics.

How It Works
Carvedilol is both a beta-blocker and an alpha blocker. It blocks the action of norepinephrine on beta-1-adrenergic receptors, beta-2-adrenergic receptors, and alpha-1-adrenergic receptors, which has the effect of slowing heartrate, partially preventing the constriction of the blood vessels,

 

Dosage
Tablets (3.125 mg, 6.25 mg, 12.5 mg, 25 mg)
Coreg should be taken with food to slow the rate of absorption and reduce the incidence of orthostatic effects.
The recommended starting dose of Carvedilol is 3.125 mg twice daily for 2 weeks. If tolerated, patients may have their dose increased to 6.25, 12.5, and 25 mg twice daily over successive intervals of at least 2 weeks. Patients should be maintained on lower doses if higher doses are not tolerated. A maximum dose of 50 mg twice daily has been administered to patients with mild-to-moderate heart failure weighing over 185 lbs
Patients should be advised that initiation of treatment and (to a lesser extent) dosage increases may be associated with transient symptoms of dizziness or lightheadedness within the first hour after dosing. During these periods, patients should avoid situations such as driving or hazardous tasks, where symptoms could result in injury. Vasodilatory symptoms often do not require treatment, but it may be useful to separate the time of dosing of Coreg from that of the ACE inhibitor or to reduce temporarily the dose of the ACE inhibitor. The dose of Coreg should not be increased until symptoms of worsening heart failure or vasodilation have been stabilized.

 

For hypertension:
The recommended starting dose of Coreg is 6.25 mg twice daily. If this dose is tolerated, using standing systolic pressure measured about 1 hour after dosing as a guide, the dose should be maintained for 7 to 14 days, and then increased to 12.5 mg twice daily if needed, based on trough blood pressure, again using standing systolic pressure one hour after dosing as a guide for tolerance. This dose should also be maintained for 7 to 14 days and can then be adjusted upward to 25 mg twice daily if tolerated and needed. The full antihypertensive effect of Coreg is seen within 7 to 14 days. Total daily dose should not exceed 50 mg. 

 

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Precautions
Do not abruptly discontinue use of Coreg, consult a doctor if experiencing negative side effects. Consult a doctor before taking Coreg if you are pregnant or breastfeeding, if you are allergic to any of its ingredients, or if you have or have a history of liver disease, asthma, sinus bradycardia, second or third degree atrioventricular block, cardiogenic shock, severe heart failure, other breathing problems, other heart problems, diabetes, hyperthyroidism, kidney disease, blood circulation problems, skin conditions, mental or mood disorders, pheochromocytoma, or myasthenia gravis.

Initiation of treatment and (to a lesser extent) dosage increases may be associated with transient symptoms of dizziness or lightheadedness (and rarely syncope) within the first hour after dosing. During these periods, patients should avoid situations such as driving or hazardous tasks, where symptoms could result in injury. Taking this medication with food will also help decrease these effects. Caution is advised when using this drug in the elderly because they may be more sensitive to its effects, especially dizziness and lightheadedness.

Patients with coronary artery disease, who are being treated with Coreg, should be advised against abrupt discontinuation of therapy. Severe exacerbation of angina and the occurrence of myocardial infarction and ventricular arrhythmias have been reported in angina patients following the abrupt discontinuation of therapy with beta-blockers. The last 2 complications may occur with or without preceding exacerbation of the angina pectoris. As with other beta-blockers, when discontinuation of Coreg is planned, the patients should be carefully observed and advised to limit physical activity to a minimum. Coreg should be discontinued over 1 to 2 weeks whenever possible. If the angina worsens or acute coronary insufficiency develops, it is recommended that Coreg be promptly reinstituted, at least temporarily. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue therapy with Coreg abruptly even in patients treated only for hypertension or heart failure.

Worsening heart failure or fluid retention may occur during up-titration of carvedilol. If such symptoms occur, diuretics should be increased and the carvedilol dose should not be advanced until clinical stability resumes.

In heart failure patients with diabetes, carvedilol therapy may lead to worsening hyperglycemia, which responds to intensification of hypoglycemic therapy. It is recommended that blood glucose be monitored when carvedilol dosing is initiated, adjusted, or discontinued.
Beta-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. Caution should be exercised in such individuals.

Patients with bronchospastic disease (chronic bronchitis and emphysema) should, in general, not receive beta-blockers. Coreg may be used with caution. In clinical trials, Coreg caused bradycardia in about 2% of hypertensive patients, 9% of heart failure patients, and 6.5% of myocardial infarction patients with left ventricular dysfunction. If pulse rate drops below 55 beats/minute, the dosage should be reduced.
If treatment with Coreg is to be continued perioperatively, particular care should be taken when anesthetic agents which depress myocardial function, such as ether, cyclopropane, and trichloroethylene, are used Patients with cardiogenic shock or who have decompensated heart failure requiring the use of intravenous inotropic therapy, should first be weaned from intravenous therapy before initiating Coreg.
Coreg is not approved for children under 18 years of age.

Drug Interactions
Consult a doctor before taking Coreg if you are taking ACE inhibitors, antidepressants, antidiabetics, calcium channel blockers, cimetidine, cyclosporine, epinephrine, general anaesthetics, other heart medications, other antihypertensives, nonsteroidal anti-inflammatory drugs (NSAIDs), rifampin, theophylline, diuretics, or any drug that may increase your heart rate or blood pressure. Patients taking both, agents with beta-blocking properties and a drug that can deplete catecholamines (ex. reserpine and monoamine oxidase inhibitors) should be observed closely for signs of hypotension or bradycardia.

Concomitant administration of clonidine with agents with beta-blocking properties may potentiate blood-pressure- and heart-rate-lowering effects. When concomitant treatment with agents with β-blocking properties and clonidine is to be terminated, the β-blocking agent should be discontinued first. Clonidine therapy can then be discontinued several days later by gradually decreasing the dosage. Agents with beta-blocking properties may enhance the blood-sugar-reducing effect of insulin and oral hypoglycemics. Therefore, in patients taking insulin or oral hypoglycemics, regular monitoring of blood glucose is recommended

Adverse/Side Effects
You may experience dizziness, lightheadedness, drowsiness, tiredness, diarrhea, unusual dreams, trouble sleeping, dry eyes, or vision problems as your body adjusts to the medication. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
This drug may reduce blood flow to your hands and feet, causing them to feel cold. Smoking may worsen this effect. Dress warmly and avoid tobacco use.

Tell your doctor immediately if any of these unlikely but serious side effects occur: symptoms of a very slow heartbeat (e.g., persistent dizziness, fainting, unusual fatigue), fainting, bluish discoloration of the fingers and toes, numbness/tingling/swelling of the hands or feet, decreased sexual ability, reversible hair loss, mental/mood changes, worsening of heart failure symptoms (e.g., cough, trouble breathing, sudden weight gain), change in the amount of urine, increased thirst, increased urination, easy bruising or bleeding, persistent sore throat or fever, yellowing skin or eyes, stomach pain, dark urine, persistent nausea.

In the unlikely event you have a serious allergic reaction to this drug, seek medical attention immediately. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing.

Overdose
If you suspect overdose, contact your local poison control center or emergency room immediately.  
Symptoms of overdose include hypotension, bradycardia, cardiac insufficiency, cardiogenic shock, and cardiac arrest. Respiratory problems, bronchospasms, vomiting, lapses of consciousness, and generalized seizures may also occur. The patient should be placed lying down and, kept under observation and treated under intensive-care conditions. Gastric lavage or pharmacologically induced emesis may be used shortly after ingestion. The following agents may be administered:
For excessive bradycardia: Atropine, 2 mg IV.

To support cardiovascular function: Glucagon, 5 to 10 mg IV rapidly over 30 seconds, followed by a continuous infusion of 5 mg/hour
If peripheral vasodilation dominates, it may be necessary to administer adrenaline or noradrenaline with continuous monitoring of circulatory conditions. For therapy-resistant bradycardia, pacemaker therapy should be performed. For bronchospasm, β-sympathomimetics (as aerosol or IV) or aminophylline IV should be given. In the event of seizures, slow IV injection of diazepam or clonazepam is recommended.
Note: In the event of severe intoxication where there are symptoms of shock, treatment with antidotes must be continued for a sufficiently long period of time consistent with the 7- to 10-hour half-life of carvedilol.

Cases of over dosage with Coreg, alone or in combination with other drugs have been reported. Quantities ingested in some cases exceeded 1,000 milligrams. Symptoms experienced included low blood pressure and heart rate. Standard supportive treatment was provided and individuals recovered.

Storage Instructions
Store at room temperature, away from moisture and light, and out of reach of children and pets.
 

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