Drug Name Dosages Therapeutic Indications Adverse effects Contraindications Nursing considerations

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carvedilol Oral  Carvedilol  Hypertension, alone Bradycardia, AV Hypersensitivity; Assessment
(kar vah' da lol)  hypertension causes or with other oral block, angina severe chronic  History: CHF,
Coreg o Adult: Initially, vasodilation by drugs, especially pectoris, heart failure, bronchial asthma,
12.5 mg once blocking the diuretics hypervolemia, bronchial asthma heart block,
Pregnancy daily increased to activity of α- leucopenia, or related cardiogenic shock,
Category C 25 mg once daily blockers, mainly  Treatment of mild to hypotension, bronchospastic hypersensitivity to
after 2 days. at alpha-1 severe CHF of peripheral conditions; carvedilol, pregnancy,
Drug classes Alternatively, receptors. It ischemic or edema, allergy, severe hepatic lactation, hepatic
 Alpha- and initial dose of exerts cardiomyopathic malaise, fluid impairment. impairment, peripheral
beta- 6.25 mg bid antihypertensive origin with digitalis, overload, Patients with vascular disease,
adrenergic increased to 12.5 effect partly by diuretics, ACE melena, NYHA class IV thyrotoxicosis,
blocker mg bid after 1-2 reducing total inhibitors periodontitis, cardiac failure, diabetes, anesthesia
 Antihypertens wk, increased peripheral hyperuricemia, 2nd or 3rd ° AV or major surgery
ive further if resistance and  Left ventricular hyponatremia, block, sick sinus  Physical: Baseline
necessary to 50 vasodilation. It is dysfunction (LVD) increased syndrome (unless weight, skin condition,
mg once daily or used in patients after MI alkaline a permanent neurologic status, P,
in divided doses. with renal phosphatase, pacemaker is in BP, ECG, respiratory
impairment,  Unlabeled uses: glycosuria, place), status, LFTs, renal
o Elderly: 12.5 mg NIDDM or IDDM. Angina (25–50 mg prothrombin cardiogenic shock and thyroid function
once daily. bid) time, SGPT and or severe tests, blood and urine
Absorption: SGOT levels, bradycardia. glucose
 Angina pectoris Absorbed well from purpura, Lactation.
the GI tract (oral); somnolence, Interventions
o Adult: Initially, peak plasma impotence,  WARNING: Do not
12.5 mg bid concentrations after albuminuria, discontinue drug
increased to 25 1-2 hr. hypokinesia, abruptly after chronic
mg bid after 2 Distribution: nervousness, therapy
days. Enters breast milk. sleep disorder, (hypersensitivity to
Protein-binding: skin reaction, catecholamines may
>98%. tinnitus, dry have developed,
 heart failure mouth, anemia,
Metabolism: causing exacerbation
Hepatic: sweating, of angina, MI, and
o Adult: Initially,
Considerable first- fatigue, ventricular
3.125 mg bid,
pass effect. arthralgia, arrhythmias); taper
doubled to 6.25
Excretion: Via bile aggravation, drug gradually over 2
mg bid after 2 wk if
(as metabolites); 6- dizziness. wk with monitoring.
tolerated, then
10 hr (elimination Diarrhea,
gradually  Consult with physician
half-life). nausea,
increased to the about withdrawing
vomiting,
max dose the drug if patient is to
insomnia,
patient can undergo surgery
hypercholesterol
tolerate at intervals (withdrawal is
emia, weight
of not <2 wk. Max controversial).
gain, abnormal
dose: >85 kg: 50
 mg bid; <85 kg: 25 vision, rhinitis,  Give with food to
mg bid. pharyngitis and decrease orthostatic
hypertriglyceride hypotension and
 Left ventricular mia. adverse effects.
dysfunction post
myocardial  Monitor for orthostatic
infarction hypotension and
provide safety
o Adult: Initially: precautions.
6.25 mg bid, if
tolerated, after 3-  Monitor diabetic
10 days, increase patient closely; drug
to 12.5 mg bid and may mask
then to a target hypoglycemia or
dose of 25 mg bid. worsen
hyperglycemia.

 WARNING: Monitor
patient for any sign of
hepatic impairment
(pruritus, dark urine or
stools, anorexia,
jaundice, pain);
arrange for LFTs and
discontinue drug if
tests indicate liver
injury. Do not restart
carvedilol.

Teaching points
 Take drug with meals.
 Do not stop taking
drug unless instructed
to do so by a health
care provider.

 Avoid use of over-the-

counter medications.

 Advise the diabetic

patient to promptly
report changes in
glucose.

 You may experience

 these side effects:
Depression,
dizziness, light-
headedness (avoid
driving or performing
dangerous activities;
getting up and
changing positions
slowly may help ease
dizziness).

 Report difficulty
breathing, swelling of
extremities, changes
in color of stool or
urine, very slow heart
rate, continued
dizziness.