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1 Bradycardia, heart block or sick sinus syndrome (unless a pacemaker is in place);

Uncompensated HF requiring IV inotropic agents (wean before starting carvedilol);
PDF Page #1
carvedilol (kar-ve-di-lole) Severe hepatic impairment; Asthma or other bronchospastic disorders.
Coreg, Coreg CR Use Cautiously in: HF (condition may deteriorate during initial therapy); Renal
impairment; Hepatic impairment; Diabetes mellitus (may mask signs of hypoglyce-
Classification mia); Thyrotoxicosis (may mask symptoms); Peripheral vascular disease; History of
Therapeutic: antihypertensives
Pharmacologic: beta blockers severe allergic reactions (intensity of reactions may be increased); OB: Crosses pla-
centa and may cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or res-
Pregnancy Category C piratory depression); Lactation, Pedi: Safety not established; Geri:qsensitivity to
beta blockers; initial dose reduction recommended.
Indications
Hypertension. HF (ischemic or cardiomyopathic) with digoxin, diuretics, and ACE in- Adverse Reactions/Side Effects
hibitors. Left ventricular dysfunction after myocardial infarction. CNS: dizziness, fatigue, weakness, anxiety, depression, drowsiness, insomnia, mem-
ory loss, mental status changes, nervousness, nightmares. EENT: blurred vision, dry
Action eyes, intraoperative floppy iris syndrome, nasal stuffiness. Resp: bronchospasm,
Blocks stimulation of beta1(myocardial) and beta2 (pulmonary, vascular, and uter- wheezing. CV: BRADYCARDIA, HF, PULMONARY EDEMA. GI: diarrhea, constipation, nau-
ine)-adrenergic receptor sites. Also has alpha1 blocking activity, which may result in sea. GU: erectile dysfunction,plibido. Derm: STEVENS-JOHNSON SYNDROME, TOXIC
orthostatic hypotension. Therapeutic Effects: Decreased heart rate and BP. Im- EPIDERMAL NECROLYSIS, itching, rashes, urticaria. Endo: hyperglycemia, hypoglyce-
proved cardiac output, slowing of the progression of HF and decreased risk of death. mia. MS: arthralgia, back pain, muscle cramps. Neuro: paresthesia. Misc: ANA-
Pharmacokinetics PHYLAXIS, ANGIOEDEMA, drug-induced lupus syndrome.
Absorption: Well absorbed but rapidly undergoes extensive first-pass hepatic me- Interactions
tabolism, resulting in 25 35% bioavailability. Food slows absorption.
Distribution: Unknown. Drug-Drug: General anesthetics, IV phenytoin, diltiazem, and verapamil
may causeqmyocardial depression.qrisk of bradycardia with digoxin. Amioda-
Protein Binding: 98%. rone or fluconazole may q levels. q hypotension may occur with other anti-
Metabolism and Excretion: Extensively metabolized (primarily by CYP2D6 and hypertensives, acute ingestion of alcohol, or nitrates. Concurrent use with cloni-
CYP2C9; the CYP2D6 enzyme system exhibits genetic polymorphism); 7% of pop-
ulation may be poor metabolizers and may have significantlyqcarvedilol concentra- dine q hypotension and bradycardia. May q withdrawal phenomenon from
tions and anqrisk of adverse effects); excreted in feces via bile, 2% excreted un- clonidine (discontinue carvedilol first). Concurrent administration of thyroid
changed in urine. preparations maypeffectiveness. May alter the effectiveness of insulins or oral
Half-life: 7 10 hr. hypoglycemic agents (dose adjustments may be necessary). Maypeffectiveness of
theophylline. Maypbeneficial beta1-cardiovascular effects of dopamine or dobu-
TIME/ACTION PROFILE (cardiovascular effects) tamine. Use cautiously within 14 days of MAO inhibitor therapy (may result in hy-
ROUTE ONSET PEAK DURATION potension/bradycardia). Cimetidine mayq toxicity from carvedilol. Concurrent
PO within 1 hr 12 hr 12 hr NSAIDs maypantihypertensive action. Effectiveness may bepby rifampin. Mayq
PO-CR unknown 5 hr 24 hr serum digoxin levels. Mayqblood levels of cyclosporine (monitor blood levels).
Contraindications/Precautions Route/Dosage
Contraindicated in: History of serious hypersensitivity reaction (Stevens-John- PO (Adults): Hypertension 6.25 mg twice daily, may beqq 7 14 days up to 25
son syndrome, angioedema, anaphylaxis); Pulmonary edema; Cardiogenic shock; mg twice daily or extended-release 20 mg once daily, dose may be doubled every
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
Name /bks_53161_deglins_md_disk/carvedilol 02/19/2014 12:59PM
2 PO: Take apical pulse before administering. If 50 bpm or if arrhythmia
7 14 days up to 80 mg once daily; HF 3.125 mg twice daily for 2 wk; may beqto
6.25 mg twice daily. Dose may be doubled q 2 wk as tolerated (not to exceed 25 mg
twice daily in patients 85 kg or 50 mg twice daily in patients 85 kg) or extended-
release 10 mg once daily, dose may be doubled every 2 wk as tolerated up to 80
mg once daily; Left ventricular dysfunction after MI 6.25 mg twice daily,qafter
3 10 days to 12.5 twice daily then to target dose of 25 mg twice daily; some patients
may require lower initial doses and slower titration or extended-release 20 mg
once daily, dose may be doubled every 3 10 days up to 80 mg once daily.
NURSING IMPLICATIONS
Assessment
Monitor BP and pulse frequently during dose adjustment period and pe-
riodically during therapy. Assess for orthostatic hypotension when assisting
patient up from supine position.
Monitor intake and output ratios and daily weight. Assess patient rou-
tinely for evidence of fluid overload (peripheral edema, dyspnea, rales/
crackles, fatigue, weight gain, jugular venous distention). Patients may
experience worsening of symptoms during initiation of therapy for HF.
Hypertension: Check frequency of refills to determine adherence.
Lab Test Considerations: May causeqBUN, serum lipoprotein, potassium,
triglyceride, and uric acid levels.
May causeqANA titers.
May causeqin blood glucose levels.
Toxicity and Overdose: Monitor patients receiving beta blockers for signs of
overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea,
bluish fingernails or palms, seizures). Notify health care professional immediately
if these signs occur.
Potential Nursing Diagnoses
Decreased cardiac output (Side Effects)
Noncompliance (Patient/Family Teaching)
Implementation
Do not confuse carvedilol with captopril.
Discontinuation of concurrent clonidine should be gradual, with carvedilol dis-
continued first over 1-2 wk with limitation of physical activity; then, after several
days, discontinue clonidine.
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occurs, withhold medication and notify health care professional.
Administer with food to minimize orthostatic hypotension. PDF Page #2
Administer extended-release capsulesin the morning. Swallow whole; do not
crush, break, or chew. Extended-release capsules may be opened and sprinkled
on cold applesauce and taken immediately; do not store mixture.
To convert from immediate-release to extended-release product, doses of 3.125
mg twice daily can be converted to 10 mg daily; doses of 6.25 mg twice daily can be
converted to 20 mg daily; doses of 12.5 mg twice daily can be converted to 40 mg
daily; and doses of 25 mg twice daily can be converted to 80 mg daily.
Patient/Family Teaching
Instruct patient to take medication as directed, at the same time each day, even if
feeling well. Do not skip or double up on missed doses. Take missed doses as soon
as possible up to 4 hr before next dose. Abrupt withdrawal may precipitate
life-threatening arrhythmias, hypertension, or myocardial ischemia.
Advise patient to make sure enough medication is available for weekends, holi-
days, and vacations. A written prescription may be kept in wallet in case of emer-
gency.
Teach patient and family how to check pulse and BP. Instruct them to check pulse
daily and BP biweekly. Advise patient to hold dose and contact health care profes-
sional if pulse is 50 bpm or BP changes significantly.
May cause drowsiness or dizziness. Caution patients to avoid driving or other ac-
tivities that require alertness until response to the drug is known.
Advise patient to change positions slowly to minimize orthostatic hypotension, es-
pecially during initiation of therapy or when dose is increased.
Caution patient that this medication may increase sensitivity to cold.
Instruct patient to notify health care professional of all Rx or OTC medications, vi-
tamins, or herbal products being taken and to consult health care professional be-
fore taking other Rx, OTC, or herbal products, especially cold preparations, con-
currently with this medication.
Patients with diabetes should closely monitor blood glucose, especially if weak-
ness, malaise, irritability, or fatigue occurs. Medication may mask some signs of
hypoglycemia, but dizziness and sweating may still occur.
Advise patient to notify health care professional if slow pulse, difficulty
breathing, wheezing, cold hands and feet, dizziness, confusion, depres-
sion, rash, fever, sore throat, unusual bleeding, or bruising occurs.
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carvedilol
Instruct patient to inform health care professional of medication regimen before
treatment or surgery.
Advise patient to carry identification describing disease process and medication
regimen at all times.
Hypertension: Reinforce the need to continue additional therapies for hyperten-
sion (weight loss, sodium restriction, stress reduction, regular exercise, modera-
tion of alcohol consumption, and smoking cessation). Medication controls but
does not cure hypertension.
Evaluation/Desired Outcomes
Decrease in BP without appearance of detrimental side effects.
Decrease in severity of HF.
Why was this drug prescribed for your patient?

Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.