Carvedilol

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Dosage and Administration

Inside, regardless of the meal.
- Arterial hypertension
The recommended initial dose is 6.25 - 12.5 mg (1 tablet 6.25 mg or 1/2 pills 12.5 mg - 1 tablet 12.5) once a day during the first 2 days of therapy, then on 25 mg once a day. If necessary, further dose can be increased at intervals of at least 2 weeks, bringing to the maximum recommended dose of 50 mg 1 time per day (or divided into 2 doses).
Coronary heart disease
The recommended initial dose is 12.5 mg 2 times a day for the first 2 days, then 25 mg 2 times a day. If the antianginal effect is insufficient, the dose can be increased at intervals of at least 2 weeks, bringing to a higher daily dose of 100 mg divided into 2 doses.
- Chronic heart failure
The dose is selected individually, it is necessary to carefully monitor the doctor. In patients receiving cardiac glycosides, diuretics, and ACE inhibitors, their doses should be adjusted before starting treatment with Carvedilol Canon.
The recommended initial dose is 3.125 mg (1/2 pills of 6.25 mg) 2 times a day for 2 weeks. With good tolerance, the dose is increased at intervals of at least 2 weeks to 6.25 mg 2 times a day, then to 12.5 mg 2 times a day, then to 25 mg 2 times a day. The dose should be increased to a maximum dose that is well tolerated by the patient. The recommended maximum dose is 25 mg 2 times a day for all patients with severe chronic heart failure and for patients with mild and moderate degrees of chronic heart failure with a patient's body weight less than 85 kg. In patients with mild and moderate chronic heart failure and weighing more than 85 kg, the recommended maximum dose is 50 mg 2 times a day.
Before each increase in dose, an examination by a physician is necessary to identify the possible increase in symptoms of chronic heart failure or vasodilation. When a transient increase in symptoms of chronic heart failure or fluid retention in the body should increase the dose of diuretics, although sometimes you have to reduce the dose of the drug or temporarily cancel it.
Symptoms of vasodilation can be eliminated by reducing the dose of diuretics. If the symptoms persist, you can reduce the dose of the ACE inhibitor (if the patient is taking it), and then, if necessary, reduce the dose of the drug Carvedilol Canon. In such a situation, the dose of carvedilol canon should not be increased until the symptoms of exacerbated chronic heart failure or arterial hypotension improve.
If treatment with Carvedilol Canon is interrupted for more than 1 week, then its use is resumed at a lower dose, and then increased in accordance with the above recommendations.
If treatment with Carvedilol Canon is interrupted for more than 2 weeks, then its reappointment should be resumed from a dose of 3.125 mg (1/2 pills of 6.25 mg) 2 times a day, then the dose should be adjusted in accordance with the above recommendations.
Dosing in special patient groups
Renal dysfunction
In patients with moderate and severe renal failure, dose adjustment of the drug Carvedilol Canon is not required.
Liver dysfunction
Carvedilol Canon is contraindicated in patients with clinical manifestations of abnormal liver function (see section "Contraindications").
Elderly patients
Data that would dictate the need for dose adjustment are not available.

Adverse reactions

WHO classification of the incidence of side effects:
very often - ≥1 / 10 appointments (> 10%)
often from ≥1 / 100 to 1% and infrequently from ≥1 / 1000 to 0.1% and rarely from ≥1 / 10,000 to 0.01% and very rarely - The frequency of some undesirable effects such as dizziness, hypotension, bradycardia visual impairment is proportional to the size of the dose and often develops in patients with CHF. If serious adverse effects develop, treatment of the drug should be discontinued.
Violations of the blood and lymphatic system
Rarely: thrombocytopenia.
Very rare: leukopenia.
Endocrine Disorders
Often: in patients with existing diabetes mellitus - hyperglycemia or hypoglycemia, impaired glycemic control.
The presence of beta-adrenergic blocking properties of the drug does not exclude the possibility of latent diabetes mellitus manifestation, decompensation of already existing diabetes mellitus or suppression of the backsynular system.
Metabolic and nutritional disorders
Often: weight gain, hypercholesterolemia.
Nervous system disorders
Often: dizziness, headache (usually light and more common at the beginning of treatment), asthenia (including fatigue), depression.
Seldom: mood / thinking changes, sleep disturbance, paresthesia, loss of consciousness.
Violations by the organ of vision
Often: eye irritation, reduced tearing (pay attention when using contact lenses).
Very rare: visual impairment.
Violations of the cardiovascular system
Very often: orthostatic hypotension.
Often: bradycardia.
Rarely: impaired cardiac conduction, aggravation of angina, worsening of the clinical picture of heart failure (especially with increasing doses), pronounced decrease in blood pressure, heartbeat, fainting, cooling hands and feet, fluid retention, hypervolemia, edema (including generalized, peripheral, depending on body position, edema of the perineum, edema of the lower extremities).
Very rarely: syncopal states (including presyncopal), occlusive disorders of the peripheral circulation, exacerbation of the syndrome of "intermittent" claudication and Raynaud's syndrome.
Disorders of the respiratory system, organs of the chest and mediastinum
Rarely: bronchospasm and shortness of breath in predisposed patients, nasal congestion.
Very rarely: sneezing.
Disorders of the gastrointestinal tract
Often: nausea, diarrhea, abdominal pain, dryness of the oral mucosa.
Seldom: vomiting, loss of appetite, flatulence, constipation.
Very rarely: increased activity of liver transaminases - alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyltransferase (GGT).
Violations of the skin and subcutaneous tissue
Very seldom: exacerbation of the course of psoriasis, exfoliative dermatitis, alopecia.
Disorders of the musculoskeletal and connective tissue
Rarely: male, pain in muscles, bones, spine.
Kidney and urinary tract disorders
Rarely: urination disorders, incontinence in women, reversible after discontinuation of the drug.
Very rare: renal failure and impaired renal function in patients with diffuse vasculitis and / or impaired renal function, edema.
Disorders of the genitals and breast
Infrequently: decrease in a potentiality.
General disorders and disorders at the site of administration
Often: general weakness.
Infrequently: hypersensitivity reaction (itchy skin, rash, urticaria).
Very rarely: "flushes" of blood to the skin of the face, flu-like syndrome.
Adverse reactions in patients with chronic heart failure
Nervous system disorders
Very often: dizziness, headache (usually light and arising at the beginning of treatment), asthenia (including fatigue), depression.
Violations of the cardiovascular system
Often: bradycardia, postural hypotension, marked reduction in blood pressure, edema (including generalized, peripheral, depending on body position, perineal edema, lower limb edema, hypervolemia, fluid retention).
Infrequently: syncopal states (including presinkopalnye), atrioventricular block and heart failure in the period of increasing doses.
Disorders of the gastrointestinal tract
Often: nausea, diarrhea, vomiting.
Violations of the blood and lymphatic system
Rarely: thrombocytopenia.
Very rare: leukopenia.
Metabolic and nutritional disorders
Often: weight gain, hypercholesterolemia; in patients with existing diabetes mellitus - hyperglycemia or hypoglycemia, a violation of carbohydrate metabolism.
Other violations
Often: visual impairment.
Rarely: renal failure and impaired renal function in patients with diffuse vasculitis and / or impaired renal function.

Contraindications

- Hypersensitivity to carvedilol or any component of the drug;
- acute and chronic heart failure in the decompensation stage, requiring intravenous administration of inotropic drugs;
- severe liver failure;
- atrioventricular block II and III degree (except for patients with an artificial pacemaker);
- severe bradycardia (heart rate less than 50 beats / min);
- sick sinus syndrome (including sinoauricular blockade);
- severe hypotension (systolic blood pressure less than 85 mm Hg. Art.);
- cardiogenic shock;
- severe forms of bronchial asthma or bronchospasm (in history);
- pheochromocytoma (without the simultaneous use of alpha-blockers);
- lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
- terminal stage of occlusive peripheral vascular disease;
- age up to 18 years (efficacy and safety have not been established).
Carefully:
With caution, the drug is used for aggravated allergic history, chronic obstructive pulmonary disease (CAPD) patients, depression, myasthenia, hypoglycemia, atrioventricular blockade of the first degree, thyrotoxicosis, with extensive surgical interventions and general anesthesia, Princarmela syndrome, anesthesia, angina, stenocardia, Pristmetocosis, with extensive surgical interventions and general anesthesia, Pristroeksikoze, with extensive surgical interventions and general anesthesia, Princarmela, octomezia, with extensive surgical interventions and general anesthesia, with Pristinocardia, Pristmetosis, with extensive surgical interventions and general anesthesia, Pristroeksikoze, with extensive surgical interventions and conducting general anesthesia, Pristrokoksikoze, with extensive surgical interventions and general anesthesia, Princarmela syndrome, Ithromyopathy, with extensive surgical interventions and general anesthesia, with Pristinocardia Chytotoxicosis; with suspected pheochromocytoma, renal failure, psoriasis.

Drug interactions

At the same time taking carvedilola and digoxin, the concentration of the latter increases by about 15%. At the beginning of carvedilol therapy, when selecting its dose or discontinuation of the drug, regular monitoring of the concentration of digoxin in the blood plasma is recommended. At the same time, combination therapy with carvedilol and digoxin may lead to an additional slowdown of atrioventricular conductivity.
In connection with pronounced individual fluctuations in the concentration of cyclosporine, careful monitoring of its concentration is recommended after initiating carvedilol therapy and, if necessary, a corresponding adjustment in the daily dose of cyclosporine. In the case of intravenous administration of cyclosporine, no interaction with carvedilol is expected.
Rifampicin reduces plasma concentrations of carvedilol, leading to a decrease in its antihypertensive effect.
Fluoxetine, ketoconazole, cimetidine, haloperidol enhance the hypotensive effect of carvedilol.
Carvedilol may enhance the hypoglycemic effect of insulin or hypoglycemic agents for oral administration. When taken together, it is recommended to regularly monitor blood glucose concentrations.
Patients taking both carvedilol and catecholamine-lowering drugs (for example, reserpine and monoamine oxidase inhibitors) should be closely monitored for the risk of arterial hypotension and / or severe bradycardia.
In patients with heart failure, concomitant use of carvedilol with amiodarone or other antiarrhythmic agents is associated with the risk of an increase in beta-adrenoceptor blocking action. However, amiodarone may increase the risk of AV conduction disturbances.
The simultaneous use of carvedilol with clonidine can potentiate the antihypertensive and bradycarditis effect.If it is planned to discontinue the combination therapy with these drugs, carvedilol should be abolished first, and clonidine after a few days, gradually reducing its dose.
Simultaneous administration of blockers of “slow” calcium channels (BCCA) of the verapamil type, diltiazem with carvedilol may increase the risk of atrioventricular conduction disturbance. It is recommended that carvedilol should be prescribed with BMCC under the control of ECG and blood pressure.
Carvedilol may enhance the effects of other concomitant antihypertensive drugs (for example, alpha1-blockers) or drugs that cause hypotension as a side effect.
for general anesthesia, the negative inotropic and hypotensive effect of carvedilol is enhanced.
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the antihypertensive effect of carvedilol.
Bronchodilators (beta-adrenoreceptor agonists). Since non-cardio selective beta-blockers interfere with the bronchodilating effect of bronchodilators, which are beta-adrenoreceptor stimulants, careful monitoring of patients receiving these drugs is necessary.

Special instructions

Overdosage

• Brand name: Carvedilol
• Active ingredient: Carvedilol
• Manufacturer: Obolensky OP
• Country of Origin: Russia