Hypersensitivity to carvedilol or other components of the drug acute and chronic heart failure (decompensation stage), severe hepatic insufficiency, atrioventricular block II-III century., Bradycardia (less than 50 u. / Min.), Sick sinus syndrome, cardiogenic shock, chronic obstructive pulmonary disease, hypotension (systolic blood pressure less than 85 mmHg) before the age of 18 years (safety and efficacy not established).
Prinzmetal angina, diabetes, hypoglycemia, hyperthyroidism, occlusive peripheral vascular disease, pheochromocytoma, depression, myasthenia gravis, psoriasis, renal failure, atrioventricular block I degree, extensive surgery and general anesthesia.
Pregnancy and lactation
Controlled trials of carvedilol in pregnant women has not been so the use of the drug in these patients is only fluoxymesterone halotestin possible in cases where the benefit to the mother outweighs the potential risk to the fetus. Do not breastfeed during treatment with carvedilol.
Dosing and Administration
Inside, drinking plenty of fluids, regardless of the meal. When hypertension – an initial dose of 1 mg 6,25-12,5 times a day during the first two days of treatment, followed by 25 mg 1 time a day. When failure hypotensive effect after 2 weeks of therapy, the dose can be increased by 2 times. The maximum recommended daily dose is 50 mg 1 time per day (possibly divided into 2 admission). Angina – initial dose is 12.5 mg 2 times a day during the first two days of treatment. Then 25 mg 2 times a day. At insufficiency antianginal effect after 2 weeks of therapy, the dose may be increased by 2 times. The maximum recommended daily dose is 100 mg per day, divided into 2 doses. In chronic heart failure the dose picked individually, under the strict supervision of a physician. The initial dose of 3.125 mg two times a day for 2 weeks, then (if tolerated) this dose increased at intervals of at least 2 weeks to 6.25 mg 2 times a day, then – 12.5 mg 2 times a day and then – to 25 mg 2 times a day. The dose should be increased to the maximum, which is well tolerated by patients. In patients weighing less than 85 kg target dose is 50 mg daily; in patients weighing more than 85 kg target dose of 75-100 mg per day. If the treatment is interrupted for more than 2 weeks, then resuming its begin with a dose of 3.125 mg two times a day, followed by increasing doses.
Side effect On the part of the central nervous system: headache (usually not severe, and at the beginning of treatment), dizziness, loss of consciousness, myasthenia gravis (usually at the beginning of treatment), sleep disturbances, depression, paresthesia, fatigue. From the side of cardiovascular system : bradycardia, orthostatic hypotension, angina pectoris, atrioventricular block, rarely – occlusive peripheral circulatory disorders, the progression of heart failure. From the digestive system: dry mouth, nausea, abdominal pain, loss of appetite, diarrhea or constipation, vomiting, increased activity of “liver “enzymes. From the hematopoietic system: . thrombocytopenia, leukopenia metabolism: increased body mass index, glucose dysregulation. allergic reactions: allergic skin reactions (rash, hives, itching, rash), exacerbation of psoriasis, nasal congestion. The respiratory system: dyspnea, and bronchospasm (in predisposed patients). Other: flu-like symptoms, fluoxymesterone halotestin pain in the limbs, “intermittent” claudication, reducing the tearing, sneezing, myalgia, arthralgia, rarely – a violation of urination, impairment of renal function.
Symptoms: marked reduction of blood pressure (accompanied by dizziness or syncope), bradycardia (less than 50 beats / min). You may experience shortness of breath due to bronchospasm and vomiting.In severe cases, possible cardiogenic shock, respiratory failure, confusion, conduction abnormalities, heart failure.
Treatment: should be monitored and corrected vital parameters, if necessary – in the ICU. Treatment – symptomatic. It is advisable to use intravenous Mr. anticholinergics (atropine) agonists (epinephrine, norepinephrine).
Interaction with other drugs
, carvedilol may potentiate the effect of other simultaneously received antihypertensive drugs (angiotensin-converting enzyme inhibitors, thiazide diuretics, vasodilators), or funds that have a hypotensive effect (nitrates).
When combined carvedilol and diltiazem may develop cardiac conduction and violations hemodynamics.
at the same time taking carvedilol and digoxin increases the concentration of the latter and may be increased during atrioventricular conduction.
carvedilol may potentiate the action of insulin and oral hypoglycemic agents, and the symptoms of hypoglycaemia (especially tachycardia) may be masked, so patients regular monitoring of blood glucose is recommended that diabetes mellitus blood.
inhibitors of microsomal oxidation (cimetidine) increase, and inductors (phenobarbital, rifampicin) weaken hypotensive effect of carvedilol.
Drugs that reduce the content of catecholamines (reserpine, monoamine oxidase inhibitors), increase the risk of hypotension and bradycardia.
At simultaneous application of cyclosporine increased the concentration of the latter (recommended daily dose of cyclosporine correction).
Co-administration of clonidine may potentiate antihypertensive and heart rate CCF the inhibiting effects of carvedilol.
General anesthetics enhance the negative inotropic and hypotensive effects of carvedilol.
Therapy should be carried out continuously and should not cease abruptly, especially in patients with coronary heart disease since it may lead to a deterioration of the underlying disease. If necessary, the reduction in dose should be gradual, in 1-2 weeks.
At the beginning of therapy or Karvedigammoy with increasing doses of the drug in patients, particularly the elderly, may experience excessive reduction in blood pressure, especially when standing up.Needed correction doses.
Patients with chronic heart failure in the selection of a dose may increase in heart failure symptoms, the appearance of edema. It is not necessary to increase the dose Karvedigammy, recommended the appointment of high doses of diuretics until the stabilization of the patient.
It is recommended constant monitoring of ECG and blood pressure, while the appointment Karvedigammy blockers and “slow” calcium channels, derivatives fenilalkilamina (verapamil) and benzothiazepine (diltiazem). and -. with antiarrhythmics class I
recommended to monitor renal function in patients with chronic renal insufficiency, arterial hypertension and chronic heart failure.
In case of surgery using general anesthesia should notify the anesthesiologist prior therapy Karvedigammoy.
Carvedilol has no effect on glucose concentration in the blood and does not cause tolerance test fluoxymesterone halotestin indicators of changes in glucose in patients with non-insulin dependent diabetes mellitus.
during treatment to avoid the use of ethanol.
patients with pheochromocytoma before therapy to assign alpha-blockers.
patients wearing contact lenses should bear in mind that the drug may cause a decrease tearing.
It is not recommended to drive at the beginning of therapy and when increasing the dose of carvedilol.
You should refrain from other activities related to the necessity of high concentration and rapid psychomotor reactions.