Carvedilol 💊

Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure

💊 Carvedilol was the first beta-blocker proven to improve survival in heart failure.

📖 About

Always check the BNF link here for updated guidance.

• Non-selective β-blocker (blocks both β1 and β2 receptors).
• Also blocks α1-receptors → causes peripheral vasodilation, reducing afterload.
• Particularly useful in heart failure with reduced ejection fraction (HFrEF).

🎯 Indications & Dosing Carvedilol (Oral)

• 🩸 Hypertension / Angina / Post-MI: Start 12.5 mg once daily → increase gradually to 25 mg twice daily (max) as tolerated.
• ❤️ Heart Failure (HFrEF): Start 3.125 mg twice daily → titrate slowly (every 2–4 weeks) up to 25 mg twice daily (max). Always start low and go slow – risk of initial decompensation.

⛔ Contraindications

• Asthma, COPD, or active bronchospasm 🫁.
• 2nd or 3rd-degree heart block.
• Bradycardia (<60 bpm) or systolic BP <100 mmHg.
• Uncontrolled / acute decompensated heart failure.
• Diabetes (especially with thiazide use – may worsen glycaemic control).
• Sick sinus syndrome.
• Severe peripheral vascular disease 🦵.

⚠️ Side Effects

• Fatigue, lethargy, cold peripheries 🥶.
• Postural hypotension, dizziness, diarrhoea.
• Bradycardia, worsening heart failure (initially).
• Worsening diabetic control (masks hypoglycaemia).
• Claudication, impotence, insomnia.
• May exacerbate psoriasis.

🔗 Interactions

• May increase ciclosporin toxicity (monitor levels closely).
• Caution with other negative chronotropes (e.g. digoxin, verapamil, diltiazem) → risk of heart block.

📚 References

• Carvedilol – BNF
• ESC Heart Failure Guidelines.
• Oxford Handbook of Clinical Medicine.