Carvedilol (Coreg) Considerations for Use*

US/FDA Approved Indication: Heart Rate Control for Atrial Fibrillation

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Black Box Warning* Abrupt cessation may exacerbate angina pectoris and MI.

Mechanism of Action

Blocks binding of catecholamines to postsynaptic alpha - 1, beta - 1, and beta - 2 receptors

Dosing

Non-acute setting or maintenance - Immediate release: 3.125 to 25 mg PO every 12 hrs (up to 50 mg every 12 hrs for patients >85 kg).

Non-acute setting or maintenance - Extended-release: 10 to 80 mg PO daily

Hepatic Impairment: Not recommended for clinically - evident hepatic impairment

Renal Impairment: No dosage adjustments are needed

Contraindications
  • Asthma
  • AV block
  • Bradycardia
  • cardiogenic shock
  • decompensated heart failure
  • sick sinus syndrome without pacer
  • hepatic disease
  • Major Side Effects

    hypotension, bradycardia, bronchospasm , HF

    Dosage forms and Strengths

    PO: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg immediate - release tablets (Coreg®) 10 mg, 20 mg, 40 mg, 80 mg extended - release capsules (Coreg® CR )

    Special Notes

    Non-selective beta-blocker.

    Abrupt cessation my precipitate angina, MI, arrhythmias, or rebound HTN; discontinue by tapering over 1-2 weeks.

    Dosing conversion:
    3.125 mg immediate-release BID = 10 mg CR
    6.25 mg immediate - release BID = 20 mg CR
    12.5 mg mg immediate - release BID = 40 mg CR
    25 mg mg immediate - release BID = 80 mg CR

    Counseling

    Do not abruptly discontinue without physician’s advice.

    Take with food and eight ounces of water at the same time every day

    Separate extended - release formulation and alcohol by at least 2 hours

    Take controlled - release formulation in the morning; the contents may be sprinkled over applesauce and consumed immediately

    * Refer to prescribing information for more complete information.
    †Dosages given in the table may differ from those recommended by the manufacturers.


    Sources:

    1. American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC). ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Washington, DC: American College of Cardiology.
    2. Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
    3. Tarascon Pocket Pharmacopoeia® 2012.