Carvedilol

dr.joan

Carvedilol:
Trade name: Coreg, Dilatrend.
Class: antihypertensive, beta blockers.
Pregnancy: (Category C)

Action:
· Blocks stimulation of beta1 (myocardial) and beta2 (pulmonary, vascular, and uterine) -adrenergic receptor sites
· Also has alpha1 blocking activity, which may result in orthostatic hypotension.
Uses:
· Management of hypertension.
· Management of CHF (due to ischemia or cardiomyopathy) with digoxin, diuretics, and ACE inhibitors.
Dose
Hypertension, initially 12.5 mg once daily, increased after 2 days to usual dose of 25 mg once daily; if necessary may be further increased at intervals of at least 2 weeks to max. 50 mg daily in single or divided doses; ELDERLY initial dose of 12.5 mg daily may provide satisfactory control Angina, initially 12.5 mg twice daily, increased after 2 days to 25 mg twice daily
Adjunct in heart failure initially 3.125 mg twice daily (with food), dose increased at intervals of at least 2 weeks to 6.25 mg twice daily, then to 12.5 mg twice daily, then to 25 mg twice daily; increase to highest dose tolerated, max. 25 mg twice daily in patients with severe heart failure or body-weight less than 85 kg and 50 mg twice daily in patients over 85 kg
Contraindications:
§ Uncompensated CHF.
§ Pulmonary edema.
§ Cardiogenic shock.
§ Bradycardia or heart block.
§ Severe hepatic impairment or bronchial asthma/bronchospasm.
Side effects:
§ Carvedilol may cause hyperglycemia, tiredness, weakness, lightheadedness, dizziness, headache,
§ diarrhea, nausea, vomiting, vision changes, joint pain, difficulty falling asleep or staying asleep
§ Cough, dry eyes, numbness, burning, or tingling in the arms or legs
Nursing considerations:
· Teach patient and family how to check pulse and blood pressure.
· May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
· Patients with diabetes should closely monitor blood sugar
· Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
· Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation).