Coreg (carvedilol) is a beta-blocker with alpha-1 blocking activity, designed to manage cardiovascular conditions by reducing strain on the heart and improving cardiac function. It is indicated for hypertension, heart failure, and post-myocardial infarction management, offering a dual mechanism that sets it apart from conventional beta-blockers. Its comprehensive action supports both hemodynamic stability and long-term cardiovascular outcomes, making it a cornerstone in modern cardiology practice.

Features

• Active ingredient: Carvedilol
• Available in immediate-release and extended-release formulations (Coreg CR)
• Dual-action: non-selective beta-adrenergic blocker with alpha-1 adrenergic blocking properties
• Dosage forms: tablets (3.125 mg, 6.25 mg, 12.5 mg, 25 mg) and extended-release capsules (10 mg, 20 mg, 40 mg, 80 mg)
• FDA-approved for hypertension, heart failure with reduced ejection fraction, and left ventricular dysfunction following myocardial infarction

Benefits

• Reduces mortality and hospitalization rates in chronic heart failure
• Lowers blood pressure effectively through vasodilation and reduced cardiac output
• Improves left ventricular ejection fraction and functional capacity
• Decreases myocardial oxygen demand, offering cardioprotective effects post-infarction
• May reduce arrhythmic events and sudden cardiac death
• Slows progression of heart failure and remodeling of the heart

Common use

Coreg is commonly prescribed for the management of mild to severe hypertension, chronic heart failure (NYHA Class II-IV), and post-myocardial infarction in patients with left ventricular dysfunction. It is also used off-label in certain arrhythmias and stable angina pectoris. Its use is supported by major clinical trials such as COPERNICUS and CAPRICORN, which demonstrated significant reductions in all-cause mortality and cardiovascular events.

Dosage and direction

Dosage must be individualized based on patient condition, tolerance, and concomitant therapy. For heart failure, initial dose is typically 3.125 mg twice daily, doubled every two weeks as tolerated to a target of 25 mg twice daily (or 80 mg once daily for Coreg CR). For hypertension, starting dose is 6.25 mg twice daily, adjusted to a maximum of 50 mg daily. For post-MI left ventricular dysfunction, begin with 6.25 mg twice daily, titrating to 25 mg twice daily. Administer with food to minimize orthostatic hypotension. Do not abruptly discontinue; taper gradually over 1-2 weeks.

Precautions

Monitor blood pressure, heart rate, and signs of worsening heart failure during initiation and titration. Use caution in patients with bronchospastic disease, diabetes (may mask hypoglycemia symptoms), thyrotoxicosis, or peripheral vascular disease. Hepatic impairment necessitates dose adjustment or avoidance. May cause dizziness or syncope, especially with initial doses. Regular assessment of renal function and electrolytes is advised. Not recommended during pregnancy unless potential benefit justifies risk.

Contraindications

Coreg is contraindicated in patients with: decompensated heart failure requiring IV inotropic therapy; bronchial asthma or related bronchospastic conditions; second- or third-degree AV block (without a permanent pacemaker); sick sinus syndrome; severe bradycardia (heart rate <50 bpm); cardiogenic shock; severe hepatic impairment; or hypersensitivity to carvedilol or any component of the formulation.

Possible side effect

Common side effects include dizziness (up to 32%), fatigue (24%), hypotension (10%), bradycardia (10%), weight gain (12%), diarrhea (6%), and hyperglycemia. Less frequently, patients may experience bronchospasm, worsening heart failure, edema, syncope, or blurred vision. Rare but serious adverse effects include hepatotoxicity, severe hypersensitivity reactions, and exacerbation of psoriasis. Most side effects are dose-dependent and often diminish with continued use or dose adjustment.

Drug interaction

Coreg interacts significantly with:

• Calcium channel blockers (verapamil, diltiazem): increased risk of bradycardia and AV block
• CYP2D6 inhibitors (fluoxetine, quinidine): increased carvedilol concentrations
• Clonidine: potentiates rebound hypertension upon withdrawal
• Insulin and oral hypoglycemics: may enhance hypoglycemic effect and mask symptoms
• Digoxin: increased digoxin levels
• Cyclosporine: elevated cyclosporine concentrations
• Antiarrhythmics (amiodarone, propafenone): additive effects on cardiac conduction

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. If using twice-daily dosing and next dose is within 4 hours, skip the missed dose. For once-daily formulations, take if remembered within 12 hours of scheduled time. Consistent dosing is important for maintaining therapeutic effect.

Overdose

Symptoms of overdose may include severe hypotension, bradycardia, cardiac failure, bronchospasm, hypoglycemia, and seizures. Management involves supportive care: administer IV fluids for hypotension, atropine for bradycardia, glucagon for hypoglycemia, and vasopressors if necessary. Hemodialysis is not effective due to high protein binding. Gastric lavage may be considered if ingestion was recent. Cardiac monitoring is essential.

Storage

Store at room temperature (20-25°C or 68-77°F) in a tightly closed container, protected from light and moisture. Keep out of reach of children and pets. Do not use beyond the expiration date. Do not store in bathroom or other humid areas. For Coreg CR, capsules should be swallowed whole and not crushed or chewed.

Disclaimer

This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual patient responses may vary. Full prescribing information should be reviewed before administration.

Reviews

Clinical trials and meta-analyses consistently demonstrate Coreg’s efficacy in reducing mortality and morbidity in heart failure and post-MI patients. In the COPERNICUS trial, carvedilol reduced all-cause mortality by 35% in severe heart failure. The US Carvedilol Heart Failure Trials Program showed a 65% reduction in mortality. Patients often report improved exercise tolerance and quality of life, though some note initial dizziness or fatigue. Overall, it remains a well-tolerated and evidence-based choice in cardiovascular therapeutics.