Medications
Carvedilol - Coreg, Coreg CR
COREG CR is an alpha-/beta-adrenergic blocking agent indicated for the treatment of:
• mild to severe chronic heart failure.
• left ventricular dysfunction following myocardial infarction in clinically stable patients.
• hypertension.
The safety profile of COREG CR was similar to that observed for immediate-release carvedilol. Most common adverse events seen with immediate-release carvedilol:
• Heart failure and left ventricular dysfunction following myocardial infarction (≥10%): Dizziness, fatigue, hypotension, diarrhea, hyperglycemia, asthenia, bradycardia, weight increase.
• Hypertension (≥5%): Dizziness
• CYP P450 2D6 enzyme inhibitors may increase and rifampin may decrease carvedilol levels.
• Hypotensive agents (e.g., reserpine, MAO inhibitors, clonidine) may increase the risk of hypotension and/or severe bradycardia.
• Cyclosporine or digoxin levels may increase.
• Both digitalis glycosides and β-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.
• Amiodarone may increase carvedilol levels resulting in further slowing of the heart rate or cardiac conduction.
• Verapamil- or diltiazem-type calcium channel blockers may affect ECG and/or blood pressure.
• Insulin and oral hypoglycemics action may be enhanced.
• Acute exacerbation of coronary artery disease upon cessation of therapy: Do not abruptly discontinue.
• Bradycardia, hypotension, worsening heart failure/fluid retention may occur. Reduce the dose as needed.
• Non-allergic bronchospasm (e.g., chronic bronchitis and emphysema): Avoid β-blockers. However, if deemed necessary, use with caution and at lowest effective dose.
• Diabetes: Monitor glucose as β-blockers may mask symptoms of hypoglycemia or worsen hyperglycemia.
