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Carvedilol (Coreg®)

By: Dr. Debra Primovic

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  • Carvedilol is a multiple-action cardiovascular agent that is further categorized as a nonselective beta-adrenoceptor antagonist and a vasodilator.
  • At high dosages, carvedilol exerts calcium channel blocking activity.
  • Because of carvedilol's afterload-reducing properties and the fact that it has fewer negative chronotropic and inotropic effects than other beta blockers, it is potentially a useful treatment for heart failure.
  • In addition, carvedilol has a protective effect on the ischemic myocardium, possibly because of a novel anti-oxidant effect that is not shared by other beta-blockers.
  • The reduction in arterial blood pressure produced by carvedilol is not associated with reflex tachycardia owing to its beta-adrenoceptor blocking activity.
  • The beta-blocking actions of carvedilol are generally evident within one hour of administration in humans.
  • Carvedilol is a prescription drug and can only be obtained from a veterinarian or by prescription from a veterinarian.
  • This drug is not approved for use in animals by the Food and Drug Administration but it is prescribed legally by veterinarians as an extra-label drug.

    Brand Names and Other Names

  • This drug is registered for use in humans only.
  • Human formulations: Coreg® (GlaxoSmithKleine)
  • Veterinary formulations: None

    Uses of Carvedilol

  • Treatment of congestive cardiac failure (sometimes in association with other pharmacologic therapies)
  • Management of hypertension

    Precautions and Side Effects

  • While generally safe and effective when prescribed by a veterinarian, carvedilol can cause side effects in some animals.
  • Carvedilol should not be used in animals with known hypersensitivity or allergy to the drug.
  • It is contraindicated in patients with bronchospastic conditions, cardiogenic shock, decompensated heart failure requiring inotropic therapy, severe liver impairment, A-V block, sick sinus syndrome, and severe bradycardia.
  • In patients with diabetes or thyroid disease, carvedilol can mask the signs of hypoglycemia and hyperthyroidism, including tachycardia. Furthermore, it may potentiate insulin-induced hypoglycemia.
  • Side effects of carvedilol include fatigue, diarrhea, bradycardia, edema, sleeplessness, dyspnea and urinary tract infections.
  • Liver function abnormalities have been noted in humans; however, no deaths have been reported.
  • During treatment with carvedilol, cardiovascular parameters, such as blood pressure (BP) and electrocardiograms (ECG) should be monitored and it is prudent to check a complete blood count (CBC) and blood chemistries periodically during prolonged therapy.

    Drug Interactions

    Carvedilol may interact with other medications. Consult with your veterinarian to determine if other drugs your pet is receiving could interact with carvedilol. Such interactions may include:

  • Carvedilol may mask signs of hypoglycemia when used with antidiabetic medications
  • When used with calcium channel blockers it may cause cardiac conduction disturbances
  • Cimetidine may increase the plasma concentration of carvedilol by 30%
  • Alpha-2 blockers (e.g. detomidine, xylazine) may potentiate the hypotensive and bradycardic effects of carvedilol
  • The plasma concentration of digoxin is increased by 15% when used concomitantly with a beta blocker, like carvedilol
  • Rifampin reduces carvedilol's plasma concentration by ~ 70%
  • SSRIs may inhibit the metabolism of some beta blockers.
  • Diphenhydramine may inhibit the metabolism of carvedilol, increasing its pharmacologic and side effects
  • Clearance of disopyramide from plasma may be reduced by carvedilol

    How Carvedilol is Supplied

  • Carvedilol is available in 3.125 mg, 6.25 mg, 12.5 mg, 25 mg tablets.

    Dosing Information

  • Medication should never be administered without first consulting your veterinarian.
  • The dosage prescribed may vary depending on the reason for prescribing.
  • The duration of administration depends on the condition being treated, response to the medication and the development of any adverse effects. Be certain to complete the prescription unless specifically directed by your veterinarian. Even if your pet feels better, the entire treatment plan should be completed to prevent relapse.
  • In dogs, the usual dose is 0.1 to 0.2 mg per pound (0.2 to 0.4 mg/kg) every 24 hours

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