II. Indication

  1. Stable Congestive Heart Failure (Compensated)

III. Mechanism: Third generation Beta Blocker (vasodilatory properties)

  1. Beta Adrenergic Receptor Antagonist
    1. Non-selective Beta Blocker
    2. Vasodilator (alpha antagonist)
  2. Blunts sympathetic drive
  3. Preserves some heart function
  4. Does not affect Blood Glucose

IV. Dosing: Stable Congestive Heart Failure

  1. Start: 3.125 mg PO bid with food
  2. Titrate up by doubling dose every 2 weeks
  3. Maximum dose
    1. Weight <85 kg: 25 mg bid
    2. Weight >85 kg: 50 mg bid
  4. Conversion from prior Beta Blocker
    1. No overlap from Metoprolol 50 mg or Atenolol 50 mg
      1. Start Carvedilol 6.25 mg bid and increase as above
    2. Overlap from Atenolol 50-150 or Metoprolol 100-200
      1. Add Carvedilol 3.125 mg bid for 2 weeks
      2. Raise Carvedilol and lower other Beta Blocker
        1. Double Carvedilol every two weeks
        2. Reduce Atenolol or Metoprolol by 50 mg q2 weeks
        3. When to stop other Beta Blocker
          1. After 2 weeks on Metoprolol 50 mg or
          2. After 2 weeks on Atenolol 25 mg
            1. Follows prior 2 weeks on Atenolol 50 mg
      3. Reference
        1. Abraham (2003) Congest Heart Fail 9:251-8 [PubMed]

V. Efficacy

  1. Carvedilol used in severe Congestive Heart Failure
    1. Findings
      1. Mean Ejection Fraction: 23%
      2. Studied over 6 months
      3. Overall mortality reduced (3.2% vs 7.8%)
    2. Reference
      1. Packer (1996) N Engl J Med 334:1349-55 [PubMed]
  2. Utah Study of Carvedilol in CHF
    1. Ejection Fraction improved 20% to 33%

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Cost: Medications

CARVEDILOL (on 2/19/2015 at Target.com)
CARVEDILOL 12.5 MG Tablet #90 for $10.00 $0.11 each
CARVEDILOL 25 MG* Tablet #90 for $10.00 $0.11 each
CARVEDILOL 3.125 MG Tablet #90 for $10.00 $0.11 each
CARVEDILOL 6.25 MG Tablet #90 for $10.00 $0.11 each
carvedilol (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
CARVEDILOL 12.5 MG TABLET Generic $0.03 each
CARVEDILOL 25 MG TABLET Generic $0.03 each
CARVEDILOL 3.125 MG TABLET Generic $0.03 each
CARVEDILOL 6.25 MG TABLET Generic $0.03 each
coreg (on 7/20/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
COREG 12.5 MG TABLET Generic $0.03 each
COREG 25 MG TABLET Generic $0.03 each
COREG 3.125 MG TABLET Generic $0.03 each
COREG 6.25 MG TABLET Generic $0.03 each
COREG CR 10 MG CAPSULE $8.07 each
COREG CR 20 MG CAPSULE $8.12 each
COREG CR 40 MG CAPSULE $8.16 each
COREG CR 80 MG CAPSULE $8.15 each

Ontology: carvedilol (C0054836)

Definition (NCI_NCI-GLOSS) A drug used to treat high blood pressure and certain heart problems. It is also being studied in the prevention and treatment of side effects caused by some anticancer drugs. Coreg blocks certain receptors on nerve cells and causes blood vessels to dilate (widen). It is a type of antihypertensive agent and a type of antianginal agent.
Definition (NCI) A synthetic antihypertensive methoxyphenoxy- 2-propanol derivative with no intrinsic sympathomimetic activity, Carvedilol acts as a nonselective beta-adrenoceptor blocking agent (S(-) enantiomer) and as an alpha 1-adrenoceptor blocker (R(+) and S(-) enantiomers). Its acts more strongly on beta-receptors than on alpha 1-receptors, reduces peripheral vascular resistance by vasodilation, and prevents reflex tachycardia (beta-blockade) so that heart rate is either unchanged or decreased. Carvedilol also reduces renin release through beta-blockade. (NCI04)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C043211
SnomedCT 108551001, 386870007
LNC LP171650-7
English carvedilol, CARVEDILOL, carvedilol (medication), carvedilol [Chemical/Ingredient], Carvedilol, Carvedilol (product), Carvedilol (substance)
Spanish carvedilol (producto), carvedilol (sustancia), carvedilol

Ontology: Coreg (C0719509)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C043211
English Coreg, coreg, GlaxoSmithKline brand of carvedilol