carvedilol (Coreg)

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Introduction

Tradename: Coreg.

Indications

* may be useful in patients with NYHA class IV heart failure[4]

Contraindications

* contraception indicated during therapy

safety in lactation = ?

Dosage

  • all dosages should be taken with food
  • start 3.125 mg PO BID for 2 weeks
  • if tolerated, increase to 6.25 mg PO BID
  • double dose every 2 weeks until maximum tolerated dose is reached
  • max dose 25 mg PO BID if < 85 kg, 50 mg BID if > 85 kg

Extended release: Coreg CR (QD dosing)

  • do NOT crush or chew the caps
  • CAN open them & sprinkle the beads on applesauce
  • diminished bioavailability relative to Coreg: conversion Coreg 6.25 mg BID -> Coreg CR 20 mg QD Coreg 12.5 mg BID -> Coreg CR 40 mg QD

Pharmacokinetics

elimination via liver

protein binding = >98 %

Adverse effects

* less tendency to cause hyperglycemia & dyslipidemia than metoprolol because of alpha-blocking[7]

Drug interactions

Mechanism of action

More general terms

Additional terms

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998 Department of Veterans Affairs, VA National Formulary
    restricted to patients with CHF
  3. Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
  4. 4.0 4.1 Journal Watch 23(6):46, 2003 Krum H, Roecker EB, Mohacsi P et al, Effects of initiating carvedilol in patients with severe chronic heart failure: results from the COPERNICUS Study. JAMA. 2003 Feb 12;289(6):712-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12585949
  5. Galaxo
  6. 6.0 6.1 Prescriber's Letter 10(7):37 2003
  7. 7.0 7.1 Prescriber's Letter 12(1): 2005 Carvedilol: is it a Better Choice in Patients with Diabetes? Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210102&pb=PRL (subscription needed) http://www.prescribersletter.com
  8. 8.0 8.1 Internal Medicine News, April 15, 2005
  9. Prescriber's Letter 14(3): 2007 New Formulation: Coreg CR (Carvedilol Extended-release) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230305&pb=PRL (subscription needed) http://www.prescribersletter.com
  10. 10.0 10.1 Deprecated Reference
  11. 11.0 11.1 Zhou H et al beta-blocker use and risk of mortality in heart failure patients initiating maintenance dialysis. Am J Kidney Dis 2021 May; 77:704 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33010357 https://www.ajkd.org/article/S0272-6386(20)31001-5/fulltext

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