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Carvedilol should not be discontinued abruptly, particularly in patients with ischemic heart disease. The withdrawal should be gradual (over a period of two weeks).
Carvedilol may induce bradycardia. If patient's pulse rate drops below 55 beats/min., the dosage of Carvedilol should be reduced, as Carvedilol is reported to cause bradycardia.
Lower starting dose of Carvedilol should be used to decrease the likelihood of syncope or hypotension.
During initiation of therapy, the patient should be cautioned to avoid situations such as driving or hazardous tasks, where injury could result, to avoid the risk of syncope.
Rarely, use of Carvedilol in patients with congestive heart failure has resulted in deterioration of renal function. Worsening of cardiac failure or fluid retention may occur during up-titration of Carvedilol. If such symptoms occur, diuretics should be increased and the Carvedilol dose should not be advanced until clinical stability resumes.
In congestive heart failure patients with diabetes, Carvedilol therapy may lead to worsening hyperglycemia, which responds to intensification of hypoglycemic therapy. It is recommended that blood glucose should be monitored when Carvedilol dosing initiated in such patients and the dose should be adjusted or the therapy should be discontinued if required.
Care should be taken in administering carvedilol to patients with history of serious hypersensitivity reactions, and in those undergoing desensitization therapy, as β-blockers may increase both the sensitivity towards allergens and seriousness of anaphylactic reactions.
Patients with history psoriasis associated with β-blocker therapy should take carvedilol only after consideration of the risk-benefit ratio.
Careful monitoring of ECG and blood pressure is necessary in patients receiving concomitant therapy with calcium channel blockers of the verapamil or diltiazem type or other antiarrhythmic drugs.
Caution should be taken in the administration of carvedilol to patients suspected of having pheochromocytoma.
Caution should be taken in the administration of carvedilol to patients suspected of having Prinzmetal's variant angina.
Wearers of contact lenses should bear in mind the possibility of reduced lacrimation.
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