Carvedilol

Indications:

• Hypertension (high blood pressure).
• Congestive heart failure (mild to severe).
• Left ventricular dysfunction after myocardial infarction.
• Angina pectoris (off-label use).

Dosage and Administration:

Administered orally, preferably with food to minimize orthostatic hypotension.

• Hypertension:
  • Initial dose: 6.25 mg twice daily.
  • Maintenance dose: 25 mg twice daily (maximum: 50 mg/day).
• Heart Failure:
  • Initial dose: 3.125 mg twice daily.
  • Gradually titrate to a maximum of 25 mg twice daily (or 50 mg twice daily for patients >85 kg), based on tolerance.
• Post-MI Left Ventricular Dysfunction:
  • Initial dose: 6.25 mg twice daily.
  • Titrate to a target dose of 25 mg twice daily.

Precautions:

1. Contraindications:

• Severe bradycardia, second- or third-degree AV block without a pacemaker.
• Decompensated heart failure requiring IV inotropes.
• Severe hepatic impairment.
• Bronchospastic conditions (e.g., asthma).

2. Caution in:

• Diabetes mellitus: May mask symptoms of hypoglycemia.
• Peripheral vascular disease: Can aggravate symptoms.
• Chronic obstructive pulmonary disease (COPD): Use with caution.

3. Pregnancy and Lactation:

• Category C: Use only if the benefits outweigh the risks.
• Not recommended during breastfeeding.

4. Drug Interactions:

• Potentiates the effects of other antihypertensives (risk of hypotension).
• Use caution with CYP2D6 inhibitors (e.g., fluoxetine) as they may increase carvedilol levels.
• Additive bradycardia with digoxin or other beta-blockers.

Benefits:

• Dual Action: Combines beta-blocking and vasodilatory effects for enhanced cardiovascular protection.
• Heart Failure Benefits: Reduces mortality and hospitalizations in patients with heart failure.
• Antioxidant Effects: May slow disease progression in chronic heart failure by reducing oxidative stress.
• Post-MI Support: Improves survival and cardiac function in patients with left ventricular dysfunction.