Although changes in blood sugar have not been observed with carvedilol, close monitoring of glycemic control is still recommended when carvedilol is initiated in diabetic patients — . In addition, periodic monitoring of lipids is recommended in patients with hypercholesterolemia who are receiving carvedilol.
One of the biggest concerns about the use of beta-blockers in heart failure is risk of acute decompensation of heart failure following initiation of therapy, similar to that observed with initiation of ACE inhibitors in patients with decompensated heart failure. Avoidance of carvedilol in patients with severe decompensated heart failure (patients exhibiting hypotension and signs of peripheral hypoperfusion) and careful dosage titration (see ‘Dosing’) can minimize the risk of these events. In addition, close monitoring for worsening of heart failure symptoms (dyspnea, peripheral edema, and decreased perfusion to skin and other peripheral organs) during the dosage titration period is required.
As with other beta-blockers, contraindications to carve-dilol include cardiogenic shock, asthma, second or third degree heart block and severe bradycardia.