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. By combining dual adrenergic blockade, Coreg offers a comprehensive approach to hemodynamic stabilization, making it a cornerstone in modern cardiology practice for patients requiring nuanced neurohormonal modulation.

Features

• Active ingredient: Carvedilol
• Available in 3.125 mg, 6.25 mg, 12.5 mg, and 25 mg tablets
• Dual-action: nonselective beta-adrenergic and alpha-1 adrenergic blockade
• Extended-release and immediate-release formulations
• FDA-approved for heart failure, hypertension, and left ventricular dysfunction post-MI

Benefits

• Reduces mortality and hospitalization in chronic heart failure
• Lowers blood pressure through vasodilation and reduced cardiac output
• Improves left ventricular ejection fraction over time
• Decreases myocardial oxygen demand, protecting ischemic myocardium
• Slows progression of heart failure symptoms
• Offers convenient twice-daily dosing for better adherence

Common use

Coreg is primarily prescribed for the management of mild to severe chronic heart failure (usually in combination with ACE inhibitors, diuretics, and digoxin), hypertension, and left ventricular dysfunction following myocardial infarction. It may also be used off-label for certain arrhythmias and migraine prophylaxis under specialist supervision.

Dosage and direction

Dosage must be individualized and titrated gradually under medical supervision. For heart failure: initial dose is 3.125 mg twice daily, doubled every two weeks as tolerated to target dose of 25 mg twice daily (for patients ≤85 kg) or 50 mg twice daily (for patients >85 kg). For hypertension: initial dose 6.25 mg twice daily, may be increased to 12.5 mg twice daily after 7-14 days, then to maximum 25 mg twice daily. For post-MI left ventricular dysfunction: start with 6.25 mg twice daily, increase to 12.5 mg twice daily after 3-10 days, then to target 25 mg twice daily. Should be taken with food to slow absorption and reduce risk of orthostasis.

Precautions

Monitor blood pressure and heart rate closely during initiation and titration. Use caution in patients with diabetes as it may mask hypoglycemia symptoms. May exacerbate heart failure or cause fluid retention during upward titration. Use with caution in patients with bronchospastic disease, peripheral vascular disease, or pheochromocytoma. Abrupt discontinuation should be avoided due to risk of rebound hypertension or angina. Regular monitoring of renal function and electrolytes recommended.

Contraindications

Patients with bronchial asthma or related bronchospastic conditions, second- or third-degree AV block, sick sinus syndrome, severe bradycardia (unless pacemaker present), cardiogenic shock, decompensated heart failure requiring IV inotropic therapy, severe hepatic impairment, or hypersensitivity to carvedilol or any component of the formulation.

Possible side effect

Most common: dizziness (up to 32%), fatigue (24%), hypotension (10%), bradycardia (10%), weight gain (10%), hyperglycemia. Less common: syncope, edema, blurred vision, diarrhea, nausea, vomiting, hypercholesterolemia. Rare but serious: hepatotoxicity, severe bradycardia, heart block, bronchospasm, worsening heart failure, allergic reactions including angioedema.

Drug interaction

Strong CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine) may increase carvedilol concentrations. Concomitant use with other beta-blockers, calcium channel blockers (especially verapamil and diltiazem), digoxin, clonidine, or antiarrhythmics may potentiate bradycardia and AV block. May enhance hypoglycemic effect of insulin and oral antidiabetics. NSAIDs may diminish antihypertensive effect. Rifampin may decrease carvedilol concentrations.

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. Maintain regular dosing schedule to ensure consistent therapeutic effect.

Overdose

Symptoms may include severe hypotension, bradycardia, cardiac failure, bronchospasm, hypoglycemia, and seizures. Management includes gastric lavage if recent ingestion, followed by supportive care including atropine for bradycardia, vasopressors for hypotension, glucagon for hypoglycemia, and bronchodilators for bronchospasm. Hemodialysis is not effective due to high protein binding.

Storage

Store at room temperature (20-25°C or 68-77°F) in original container, protected from light and moisture. Keep out of reach of children. Do not use after expiration date printed on packaging.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Individual patient responses may vary, and proper medical supervision is essential throughout treatment.

Reviews

Clinical trials demonstrate Coreg reduces mortality by 35% in heart failure patients and significantly improves functional status. The COPERNICUS trial showed 35% risk reduction in all-cause mortality in severe heart failure. U.S. Carvedilol Heart Failure Study Group reported 65% reduction in mortality risk. Most patients report improved exercise tolerance and reduced symptoms, though some note initial dizziness and fatigue during titration phase. Overall considered a well-tolerated and life-saving therapy when properly managed.