Formulary
Carvedilol: Indications, Dosing, Side Effects and Interactions
Carvedilol clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Carvedilol: Indications, Dosing, Side Effects and Interactions
Carvedilol clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): Initially 12.5 mg once daily for 2 days, then increased to 25 mg once daily; increased if necessary up to 50 mg daily, dose to be increased at intervals of at least 2 weeks and can be given as a single dose or in divided doses.
- **Elderly** (By Mouth): Initially 12.5 mg daily, initial dose may provide satisfactory control.
**Angina**
- **Adult** (By Mouth): Initially 12.5 mg twice daily for 2 days, then increased to 25 mg twice daily.
**Adjunct to diuretics, digoxin, or ACE inhibitors in symptomatic chronic heart failure**
- **Adult** (By Mouth): Initially 3.125 mg twice daily, dose to be taken with food, then increased to 6.25 mg twice daily, then increased to 12.5 mg twice daily, then increased to 25 mg twice daily, dose should be increased at intervals of at least 2 weeks up to the highest tolerated dose, max. 25 mg twice daily in patients with severe heart failure or body-weight less than 85 kg; max. 50 mg twice daily in patients over 85 kg.
**Prevention of bleeding from medium or large oesophageal varices [in patients with cirrhosis]**
- **Adult** (By Mouth): 6.25 mg once daily, increased if necessary up to 12.5 mg once daily, dose to be adjusted gradually according to heart rate and blood pressure.
**Primary prevention of decompensated cirrhosis [in patients with clinically significant portal hypertension]**
- **Adult** (By Mouth): 6.25 mg once daily, dose to be adjusted gradually according to heart rate and blood pressure.
**Adjunct in heart failure (limited information available) for carvedilol**
- **Child 2-17 years** (By mouth): Initially 50 micrograms/kg twice daily (max. per dose 3.125 mg) for at least 2 weeks, then increased to 100 micrograms/kg twice daily for at least 2 weeks, then increased to 200 micrograms/kg twice daily, then increased if necessary up to 350 micrograms/kg twice daily (max. per dose 25 mg).
**Prevention of bleeding from medium or large oesophageal varices [in patients with cirrhosis] for carvedilol**
- **Child 16-17 years** (By mouth): 6.25 mg once daily, increased if necessary up to 12.5 mg once daily, dose to be adjusted gradually according to heart rate and blood pressure.
**Primary prevention of decompensated cirrhosis [in patients with clinically significant portal hypertension] for carvedilol**
- **Child 16-17 years** (By mouth): 6.25 mg once daily, dose to be adjusted gradually according to heart rate and blood pressure.
Cautions
For all beta-adrenoceptor blockers (systemic) Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: in combination with verapamil or diltiazem (risk of heart block) with bradycardia (heart rate less than 50 beats per minute), or second- or third-degree AV block (contra-indicated; risk of complete heart block, asystole) in diabetes mellitus patients with frequent hypoglycaemic episodes (risk of suppressing hypoglycaemic symptoms) if prescribed a non-selective beta-blocker (including topical beta-blockers) in a history of asthma requiring treatment (contra-indicated in asthma; risk of increased bronchospasm)
Contraindications
For all beta-adrenoceptor blockers (systemic) Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal's angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure Contra-indications, further information Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken. Contra-indications For carvedilol Acute or decompensated heart failure requiring intravenous inotropes
Side effects
For all beta-adrenoceptor blockers (systemic) Common or very common Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; rash (reversible on discontinuation); Raynaud's phenomenon; sleep disorders; syncope; visual impairment; vomiting Uncommon Alopecia; atrioventricular block; bronchospasm Rare or very rare Hallucination; psoriasis exacerbated Side-effects, further information With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. Overdose Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. For details on the management of poisoning, see Beta-blockers, under Emergency treatment of poisoning . Side-effects For carvedilol Common or very common Anaemia; asthma; dyspepsia; eye irritation; fluid imbalance; genital oedema; hypercholesterolaemia; hyperglycaemia; hypoglycaemia; increased risk of infection; oedema; peripheral vascular disease; postural hypotension; pulmonary oedema; renal impairment; urinary disorders; weight increased Uncommon Angina pectoris; constipation; hyperhidrosis; skin reactions Rare or very rare Dry mouth; hypersensitivity; leucopenia; nasal congestion; severe cutaneous adverse reactions (SCARs); thrombocytopenia
Interactions
**Severe interactions:**
- The administration of dihydropyridines and carvedilol should be done under close supervision as heart failure and severe hypotension have been reported.
- The trough concentration of R and S-carvedilol was significantly increased by 2.2-fold in heart failure patients receiving carvedilol and amiodarone concomitantly as compared to patients receiving...
**Other interactions (28):**
- Antiarrhythmics.
- As with other beta-blockers, ECG and blood pressure should be monitored closely when concomitantly administering calcium-channel-blockers of the verapamil and diltiazem type due to the risk of AV...
- Close monitoring should be done in case of co-administration of carvedilol, and amiodarone therapy (oral) or class I antiarrhythmics.
- Bradycardia, cardiac arrest, and ventricular fibrillation have been reported shortly after initiation of beta-blocker treatment in patients receiving amiodarone.
- There is a risk of cardiac failure in case of class Ia or Ic antiarrhythmics concomitant intravenous therapy.
- An increase of steady state digoxin levels by approximately 16% and of digitoxin by approximately 13% has been seen in hypertensive patients in connection with the concomitant use of carvedilol and...
Pregnancy
For all beta-adrenoceptor blockers (systemic) Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. Pregnancy For carvedilol Information on the safety of carvedilol during pregnancy is lacking. If carvedilol is used close to delivery, infants should be monitored for signs of alpha-blockade (as well as beta-blockade).
Breast feeding
For all beta-adrenoceptor blockers (systemic) With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants. Breast feeding For carvedilol Infants should be monitored as there is a risk of possible toxicity due to alpha-blockade (in addition to beta-blockade).
Hepatic impairment
Avoid in severe impairment. M When used for Prevention of bleeding from medium or large oesophageal varices or Primary prevention of decompensated cirrhosis: Caution in mild to moderate impairment (may have greater effect on heart rate and blood pressure). A Dose adjustments Dose adjustment may be required in moderate impairment. M
Medicinal forms
Suspension
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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