Carvedilol

Carvedilol is a beta-blocker (non-selective, with alpha-blocking activity) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Chronic heart failure — mild to severe, together with other heart failure medicines
• High blood pressure (hypertension) — alone or in combination
• After a heart attack with reduced heart pumping function (left ventricular dysfunction)
• Angina (chest pain) — in selected patients

Your doctor will decide your dose of Carvedilol. In heart failure it is always started very low and doubled slowly every 2 weeks or more, watching your weight, pulse and pressure — this slow build-up is essential and must not be rushed.

• Take Carvedilol with food — this slows absorption and reduces dizziness from a sudden pressure drop.
• Usually taken twice daily at the same times each day.
• If you miss a dose, take it when remembered unless the next dose is near; never double up.
• Weigh yourself regularly in heart failure; report rapid weight gain or swelling.

Never stop Carvedilol suddenly or on your own, even when you feel fine — abrupt stopping can sharply worsen heart failure or trigger chest pain and rebound high pressure. Any change must be made gradually by your doctor.

Possible side effects of carvedilol include:

• Dizziness or light-headedness, especially after dose increases — usually settles in 1–2 weeks
• Tiredness, weakness, slow pulse
• Low blood pressure on standing
• Temporary fluid retention or slight weight gain when starting (in heart failure)
• Cold hands and feet, headache, nausea, diarrhoea
• Blurred vision, dry eyes
• Worsening wheeze in asthma patients
• Seek prompt care for fainting, very slow pulse, marked breathlessness or rapid swelling

• Monitor pulse, blood pressure and (in heart failure) daily weight; report a gain of more than 1.5–2 kg in a few days.
• Rise slowly from sitting or lying; avoid driving until dizziness settles after each dose increase.
• Tell your doctor about asthma, COPD, diabetes, liver disease, kidney disease, thyroid problems or circulation disorders.
• Diabetics: carvedilol can mask low-sugar warning signs — monitor sugar more closely.
• Wearers of contact lenses may notice dry eyes.
• Inform doctors before surgery or anaesthesia; do not stop the medicine before surgery unless instructed.
• Avoid alcohol close to dosing (especially extended-release forms) — it can speed up drug release.

• Verapamil, diltiazem: risk of very slow pulse and heart block — close monitoring needed
• Digoxin: carvedilol can raise digoxin levels and further slow the heart
• Insulin and diabetes medicines: enhanced sugar-lowering and masked hypoglycaemia symptoms
• Rifampicin: markedly reduces carvedilol levels
• Fluoxetine, paroxetine and other CYP2D6 inhibitors: may increase carvedilol effects
• Clonidine: careful sequencing needed when stopping
• Other antihypertensives, nitrates: additive pressure lowering
• NSAIDs: may blunt the blood-pressure effect

• Allergy to carvedilol or any component
• Acute decompensated heart failure needing intravenous medicines
• Severe asthma or history of severe bronchospasm
• Very slow pulse, sick sinus syndrome or second/third-degree heart block without a pacemaker
• Cardiogenic shock or severe symptomatic low blood pressure
• Severe liver impairment

Pregnancy: Carvedilol should be used in pregnancy only if your doctor judges the benefit outweighs the risk. Beta-blockers can slow the baby's growth and heart rate, and may cause low blood sugar in the newborn. Tell your doctor immediately if you are or plan to become pregnant — a safer alternative may be chosen.

Lactation: Small amounts may pass into breast milk. Breastfeeding is generally not recommended during treatment unless your doctor advises otherwise after weighing the benefits.

Store below 30°C in a dry place, protected from light and moisture. Keep in the original packaging and out of the reach of children. Do not use after the expiry date.