Coreg

Coreg (carvedilol) is a beta-blocker and alpha-blocker combination medication designed to manage cardiovascular conditions by reducing strain on the heart, improving blood flow, and optimizing cardiac function. It is widely prescribed for hypertension, heart failure, and post-myocardial infarction management. By targeting both beta and alpha adrenergic receptors, Coreg offers a dual mechanism of action that distinguishes it from conventional beta-blockers, providing comprehensive hemodynamic benefits. Its efficacy is supported by extensive clinical evidence, making it a cornerstone in cardioprotective therapy.

Features

• Active ingredient: Carvedilol
• Available in immediate-release and extended-release formulations (Coreg CR)
• Dosage forms: Tablets (3.125 mg, 6.25 mg, 12.5 mg, 25 mg); Extended-release capsules (10 mg, 20 mg, 40 mg, 80 mg)
• Dual adrenergic blockade: Non-selective beta-blocker with alpha-1 blocking activity
• FDA-approved for hypertension, heart failure (LVSD), and post-MI LVD
• Hepatic metabolism via CYP2D6 and CYP2C9 enzymes

Benefits

• Reduces mortality and hospitalization in chronic heart failure
• Lowers blood pressure through vasodilation and reduced cardiac output
• Improves left ventricular ejection fraction (LVEF) in systolic dysfunction
• Decreases myocardial oxygen demand, offering cardioprotection post-infarction
• Slows progression of heart failure symptoms and enhances functional capacity
• Provides 24-hour hemodynamic control with once-daily extended-release formulation

Common use

Coreg is indicated for the management of mild-to-severe chronic heart failure of ischemic or cardiomyopathic origin (usually administered with diuretics, ACE inhibitors, and/or digitalis), hypertension, and left ventricular dysfunction following myocardial infarction. It is also used off-label for stable angina pectoris and certain arrhythmias. Clinical use is guided by echocardiographic findings, blood pressure measurements, and functional status assessments.

Dosage and direction

Dosage must be individualized and titrated slowly under clinical supervision. For heart failure: Initiate at 3.125 mg twice daily; double dose every two weeks as tolerated to target 25 mg twice daily (50 mg twice daily for >85 kg). For hypertension: Start 6.25 mg twice daily; increase to 12.5 mg twice daily after 1-2 weeks, then 25 mg twice daily if needed. Coreg CR: Initiate at 20 mg once daily; titrate to 40 mg, then 80 mg as needed. Should be taken with food to slow absorption and reduce risk of orthostasis. Do not crush or chew extended-release capsules.

Precautions

Monitor blood pressure and heart rate during initiation and titration. Use caution in patients with diabetes (may mask hypoglycemia symptoms), thyrotoxicosis, or peripheral vascular disease. May cause worsening heart failure during titration period. Abrupt withdrawal should be avoided (taper over 1-2 weeks). Not recommended during pregnancy unless potential benefit justifies risk. Use with caution in hepatic impairment (Child-Pugh Class B or C). Regular monitoring of renal function advised.

Contraindications

Patients with decompensated cardiac failure requiring IV inotropic therapy, bronchial asthma or related bronchospastic conditions, second- or third-degree AV block, sick sinus syndrome (unless pacemaker present), severe bradycardia (<50 bpm), cardiogenic shock, or severe hepatic impairment. 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 (12%), diarrhea (12%). Serious: worsening heart failure, bronchospasm, hepatotoxicity, severe bradycardia/hypotension, masking of hypoglycemia in diabetics. Other: hyperglycemia, edema, blurred vision, syncope, AV block, peripheral ischemia, impotence.

Drug interaction

Strong CYP2D6 inhibitors (quinidine, fluoxetine, paroxetine) may increase carvedilol levels. Concomitant use with other beta-blockers, calcium channel blockers (especially verapamil/diltiazem), or digoxin may potentiate bradycardia and AV block. Clonidine withdrawal may be exacerbated. May enhance insulin/oral hypoglycemic effects. NSAIDs may diminish antihypertensive effect. Cyclosporine increases carvedilol concentrations. Use with reserpine may cause excessive catecholamine depletion.

Missed dose

If missed, take as soon as remembered unless close to next dose. Do not double dose. For twice-daily regimen: if next dose is within 4 hours, skip missed dose. For once-daily CR: take if remembered within 12 hours of missed time.

Overdose

Symptoms: severe hypotension, bradycardia, cardiac failure, bronchospasm, hypoglycemia, seizures. Treatment: gastric lavage if recent ingestion. Supportive care: atropine for bradycardia, vasopressors (norepinephrine preferred over epinephrine) for hypotension, glucagon for refractory cases, bronchodilators for bronchospasm. Hemodialysis not effective due to high protein binding.

Storage

Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F). Protect from moisture and light. Keep in original container. Do not remove desiccant from Coreg CR bottle. Keep out of reach of children.

Disclaimer

This information is for educational purposes and does not replace professional medical advice. Dosage and treatment decisions must be made by a qualified healthcare provider based on individual patient characteristics. Not all possible uses, interactions, or adverse effects are listed here.

Reviews

Clinical trials demonstrate mortality risk reduction of 35% in heart failure patients (CAPRICORN trial) and 65% risk reduction in sudden death (COPERNICUS trial). Real-world studies confirm improved ejection fraction (mean increase 6-8%) and NYHA class improvement in 60-70% of heart failure patients. Hypertension studies show 12-15 mmHg systolic and 8-10 mmHg diastolic reduction. Most common patient-reported benefits include reduced dyspnea, increased exercise tolerance, and decreased hospitalizations. Main complaints involve initial fatigue/dizziness during titration.