Carvedilol
Brand names: Coreg
Class: ❤️ Beta-Blockers
When a vignette puts you on a heart-failure beta-blocker, carvedilol is one of three with HFrEF mortality evidence — alongside metoprolol succinate and bisoprolol. It blocks beta-1, beta-2, and alpha-1 receptors, lowering blood pressure while reducing heart rate and remodeling. The alpha-1 effect makes it the preferred HFrEF agent when hypertension is also present. Take with food to slow absorption and reduce orthostasis. Start low, go slow, and titrate every two weeks once the patient is euvolemic. Never start a beta-blocker in decompensated heart failure. Non-selective activity means caution in asthma and severe COPD; cardioselective metoprolol succinate is the safer choice when bronchospasm is a concern.
✅ Indications
CHF (HFrEF), HTN, post-MI with LV dysfunction.
⚙️ Mechanism of Action
Non-selective β + α₁-blocker.
📏 Dosing
CHF: 3.125 mg BID, double every 2 weeks to target 25 mg BID (50 mg BID if >85 kg).
🚫 Contraindications
Severe bradycardia, decompensated HF, AV block without pacemaker, asthma (non-selective).
⚠️ Adverse Effects
Bradycardia, hypotension, dizziness (esp at start), fatigue, ↑ BG.
🔬 Monitoring
BP, HR, weight, CHF signs/symptoms.
💎 Board Pearls
- 🏆 Best-in-class CHF mortality benefit (added α-blockade → afterload reduction).
- 📉 START LOW, GO SLOW in CHF — NEVER initiate during acute decompensation.
Related Drugs in This Class
- Metoprolol — Lopressor (tartrate), Toprol-XL (succinate)
- Propranolol — Inderal
- Labetalol — Trandate, Normodyne
Sources
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