Beta blockers · Cardiovascular
Carvedilol
Coreg®(brand names vary by market)
The beta blocker that also opens arteries, which is why heart failure likes it.
Also: modified release
Mechanism
Non-selective beta blockade plus alpha-1 antagonism: the usual cardiac braking, with vasodilation that offloads the failing ventricle instead of adding to its work.
Open the interactive pathwayIndications
- Heart failure with reduced ejection fraction
- Hypertension
- Post myocardial infarction
Formulations
Dosing concepts
Titration
Start very low and double at intervals of no less than two weeks. The target is the dose used in the trials, not the dose that happens to control the blood pressure.
With food
Taken with food, which slows absorption and blunts the orthostatic hypotension that otherwise ends the titration early.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~25% (extensive first-pass)
- Half-life
- 7 to 10 h
- Elimination
- hepatic: CYP2D6 and CYP2C9; the active enantiomers are affected differently
- Protein binding
- ~98%
Adverse effects
- Dizziness and orthostatic hypotensioncommonWorst in the first days after each increase; taking it with food helps.
- Bradycardiacommon & serious
- Fatiguecommon
- Worsening congestion during up-titrationseriousA transient dip is expected; a rising weight means slowing down, not stopping.
- BronchospasmseriousNon-selective, so more of a problem in asthma than metoprolol or bisoprolol.
Contraindications & precautions
Contraindications
- Decompensated heart failure requiring intravenous inotropes
- Severe bradycardia or high-grade AV block
- Severe asthma
Precautions
- Asthma and COPD
- Hepatic impairment
- Diabetes with hypoglycemia unawareness
- Abrupt discontinuation
Interactions
- Beta blockers + Verapamil / diltiazemcautionBradycardia, AV block, hypotension, occasionally pacing-level.
- Beta blockers + Insulin / sulfonylureasmonitorHypoglycemia without its alarm bells; sweating persists as the surviving symptom.
- Non-selective beta blockers + SalbutamolcautionBlunted bronchodilation exactly when the patient reaches for rescue.
Monitoring
Blood pressure sitting and standing
The alpha blockade makes orthostasis the rate-limiting effect · Before and after each increase
Heart rate
Titration endpoint
Daily weight and congestion symptoms
Beta blockade transiently reduces output before it helps
Counselling points
- Take it with food, at the same times each day.
- You may feel light-headed or more tired for a week or two after each increase; this usually settles and is not a reason to stop.
- Stand up slowly, especially at night.
- Weigh yourself daily and report a gain of more than about two kilograms in a few days.
- Never stop it suddenly.
Clinical pearls
- The dizziness that makes patients give up on carvedilol is alpha-1 blockade, not the beta effect, and it fades. Coaching a patient through the first fortnight is often the difference between a trial-dose and a target dose.
- In heart failure the beta blocker is started when the patient is dry and stable, and the dose is not increased during an exacerbation. It is a long-term drug being introduced during a chronic disease, not a treatment for today's breathlessness.
References & review
- Carvedilol product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-16 · jurisdiction: global · drug information changes; verify against current references before practice use.