HTN Initially 12.5 mg once daily, increased after 2 days to 25 mg once daily. Alternatively, initially 6.25 mg bid, increased after 1-2 wk to 12.5 mg bid. Dose may be increased further if necessary at intervals of at least 2 wk to 50 mg once daily or in divided doses. Elderly 12.5 mg once daily may be adequate. Angina pectoris Initially 12.5 mg bid, increased after 2 days to 25 mg bid. Heart failure Initially 3.125 mg bid. If tolerated, dose should be doubled after 2 wk to 6.25 mg bid & then increased gradually at intervals of not <2 wk to max dose tolerated (not to exceed 25 mg bid in patient <85 kg or 50 mg bid in patient >85 kg).
Patients w/ history of serious hypersensitivity reactions & those undergoing desensitization therapy; pheochromocytoma; DM; history of psoriasis associated w/ β-blocker therapy; signs & symptoms of unstable angina; peripheral vascular disease particularly Raynaud's disease; cardiac failure over NYHA class II, insufficiency of salts &/or body fluids (administering high-dose diuretic), hypotension (administration when initial systolic BP <100 mmHg) & elderly >70 yr; suspected Prinzmetal's variant angina. Gradually reduce dose if cardiac rate drops to <55 times/min; carefully administer in case of 1st degree AV block. May obscure symptoms of cardiothyrotoxicosis. Possibility of reduced lacrimation in wearers of contact lenses. Regularly monitor blood glucose in diabetics when treatment is initiated or up-titrated & hypoglycemic therapy adjusted accordingly. Monitor renal function in case of initial administration & dose increase in patients who have ischemic heart disease, diffuse angiosis or renal adequacy w/ hypotension (systolic BP <100 mmHg). Not to be discontinued abruptly in patients suffering from chronic stable angina & ischemic heart disease (gradually w/draw over 1-2 wk). W/draw carvedilol first, several days before gradually decreasing dose of clonidine, when concomitant treatment is to be terminated. Individual varying reactions can impair alertness eg, capacity for driving or operating machinery. Not to be used during pregnancy. Not recommended during lactation. Safety & efficacy in childn <18 yr have not been established.
Increased steady-state trough conc of digoxin. Cardiac rate may be remarkably low & AV conduction may be delayed w/ cardiac glycoside. Reaction of drugs having other activity of descending BP or descending BP as side effect eg, sedatives (eg, barbiturate & phenothiazine, antidepressant, vasodilator, alcohol) may be increased. Cardiac rate may be more reduced w/ reserpine, guanethidine, methyldopa, clonidine & guanfacine. Isolated cases of conduction disturbances (rarely w/ haemodynamic compromise) w/ diltiazem. Carefully monitor ECG & BP when concomitantly administering Ca-channel blockers of the verapamil or diltiazem type, or class 1 antiarrhythmic drugs. Effect of descending BP may be reduced w/ COX inhibitor eg, ASA & corticosteroid. May enhance effects of insulin or oral hypoglycemics. Serum levels may be reduced w/ inducers of mixed function oxidases (eg, rifampicin) or may be increased w/ inhibitors of mixed function oxidases (eg, cimetidine). Synergistic -ve inotropic & hypotensive effects w/ anesth. Closely monitor cyclosporine conc after carvedilol initiation; adjust cyclosporine dose as appropriate.
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