Category Archives: Carvedilol

Carvedilol: DOSING

The initial dose of carvedilol in the management of CHF is 3.125 mg bid for two weeks, followed by 6.25 mg bid for two more weeks; the dose is then doubled every two weeks up to a maximum of 25 mg bid for patients weighing less than 85 kg or 50 mg bid for patients weighing more than 85 kg. With each dosage increase it … Continue reading

Carvedilol: DRUG INTERACTIONS

Carvedilol should be administered cautiously with digoxin, calcium channel blockers (especially verapamil and dilti-azem) and other beta-blockers because an increase in the incidence of bradycardia and atrioventricular nodal conduction disturbances (second and third degree heart block) is expected. Because carvedilol can also increase serum digoxin concentrations by 16% , monitoring serum digoxin levels is recommended during concurrent therapy. Administration of carvedilol with other antihypertensives may … Continue reading

Carvedilol: ADVERSE EFFECTS(2)

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.

Carvedilol: ADVERSE EFFECTS(1)

The adverse effect profile of carvedilol is similar to that of other alpha- and beta-blockers. From clinical trials, the most frequently reported adverse events are headache (8%) and dizziness (7%), as well as tiredness and weakness (4%) . These effects tend to be more pronounced in the elderly and in patients with more severe heart failure (NYHA classes III and IV) . The incidence of … Continue reading

Carvedilol: PLACE OF CARVEDILOL IN THE THERAPY OF CHF

There is increasing evidence that activation of both the SNS and the RAAS contributes to disease progression in heart failure, thereby establishing a role for the use of both beta-blockers and ACE inhibitors in the management of these patients. With the amount of evidence (large number of trials including thousands of patients) demonstrating a benefit of reduced mortality and morbidity with the use of ACE … Continue reading

Carvedilol: CARVEDILOL IN CHF(10)

All patients in that study had heart failure secondary to IDCM. Despite a similar degree of beta-blockade (as measured by heart rate reduction) and hemodynamic benefit (increases in EF and stroke work index), only carvedilol was associated with improvements in NYHA functional class. Furthermore, only metoprolol was associated with an increase in noradrenaline levels and beta-receptor density. Carvedilol, in contrast, decreased noradrenaline levels and was … Continue reading

Carvedilol: CARVEDILOL IN CHF(9)

Furthermore, there are limited data on the use ofcarvedilol in patients with more severe heart failure, who are most likely to decompensate following abrupt withdrawal of their compensatory mechanisms. Most of the available data are based on patients with mild to moderate heart failure (NYHA classes II and III, with average EFs of greater than 20%). The only trial that included patients with more severe … Continue reading

Carvedilol: CARVEDILOL IN CHF(8)

While both of these studies demonstrated a reduction in the combined end-point of death and hospitalizations, only the United States study found a significant mortality reduction. Differences in the study population (CHF secondary to ischemic heart disease versus IDCM, age, baseline EF), duration of follow-up, sample size and practice patterns between the two countries may account for these discrepant results. It is also interesting to … Continue reading

Carvedilol: CARVEDILOL IN CHF(7)

Studies with carvedilol have demonstrated more consistent benefits (hemodynamics, functional class) in patients with heart failure secondary to both IDCM and ischemia (Table 2). The two largest carvedilol trials are from the Australia-New Zealand Heart Failure Research Collaborative Group and the United States Carvedilol Heart Failure Study Group. Although the Australia-New Zealand group found a significant improvement in EF in patients receiving carvedilol, they were … Continue reading

Carvedilol: CARVEDILOL IN CHF(6)

The two largest trials evaluating the use of beta-blockers in heart failure were the Multicenter Dilated Cardiomyopathy Trial (MDC) and the Cardiac Insufficiency Bisoprolol Study (CIBIS) (Table 1). Neither of these trials was able to demonstrate a survival benefit with the use of beta-blockers. The MDC trial , which comprised patients with heart failure secondary to IDCM only, demonstrated no difference in mortality with the … Continue reading