carvedilol (Rx)

Brand and Other Names:Coreg, Coreg CR
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule, extended release

  • 10mg
  • 20mg
  • 40mg
  • 80mg

tablet

  • 3.125mg
  • 6.25mg
  • 12.5mg
  • 25mg

Congestive Heart Failure

Immediate release

  • 3.125 mg PO q12hr for 2 weeks, then increased every 2 weeks as tolerated to 6.25 mg, 12.5 mg, or 25 mg PO twice daily
  • Maximum recommended dosage (mild-to-moderate heart failure): <85 kg, 25 mg PO q12hr; >85 kg: 50 mg PO twice daily
  • Maximum recommended dosage (severe heart failure): 25 mg PO twice daily

Extended release

  • 10 mg/day PO; maintained for 1-2 weeks if tolerated; may be increased to 20 mg/day, 40 mg/day, or 80 mg/day PO if necessary

Hypertension

Immediate release: 6.25 mg PO twice daily initially; after 7-14 days, increased as tolerated, first to 12.5 mg PO twice daily and then to 25 mg PO twice daily

Extended release: 20 mg/day PO; maintained for 1-2 weeks if tolerated; may be increased to 40 mg/day PO if necessary; not to exceed 80 mg/day PO

Left Ventricular Dysfunction Following Myocardial Infarction

Immediate release: 3.125-6.25 mg PO q12hr initially; after 3-10 days, increased as tolerated, first to 12.5 mg PO q12hr and then to 25 mg PO q12hr (target dosage)

Extended release: 10-20 mg/day PO; increased every 3-10 days as tolerated up to 80 mg/day PO (target dosage)

Angina pectoris

25-50 mg PO twice daily

Dosing Modifications

Renal impairment: No dosage adjustments necessary

Hepatic impairment: Contraindicated in severe liver impairment

Conversion to Extended Release Form

3.125 mg twice daily: Administer 10 mg PO qDay

6.25 mg twice daily: Administer 20 mg PO qDay

12.5 mg twice daily: Administer 40 mg PO qDay

25 mg twice daily: Administer 80 mg PO qDay

Administration

To be taken with food

May break capsule and sprinkle on spoonful of applesauce; to be eaten immediately

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and carvedilol

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              Serious - Use Alternative (45)

              • acebutolol

                acebutolol and carvedilol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • afatinib

                carvedilol increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

              • artemether/lumefantrine

                artemether/lumefantrine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • atenolol

                atenolol and carvedilol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • betaxolol

                betaxolol and carvedilol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • bisoprolol

                bisoprolol and carvedilol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • bosutinib

                carvedilol increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • celiprolol

                carvedilol and celiprolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • chlorpromazine

                carvedilol, chlorpromazine. Either increases levels of the other by decreasing metabolism. Contraindicated. Not all beta blockers share this interaction (e.g., atenolol, nadolol, sotalol do not interact).

              • colchicine

                carvedilol will increase the level or effect of colchicine by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid use of colchicine with P-gp inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with P-gp inhibitors is contraindicated in patients with renal or hepatic impairment.

              • dacomitinib

                dacomitinib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

              • edoxaban

                carvedilol will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

              • efavirenz

                efavirenz will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug.

              • erdafitinib

                erdafitinib will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

              • esmolol

                carvedilol and esmolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • fluoxetine

                fluoxetine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • givosiran

                givosiran will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

              • iobenguane I 131

                carvedilol will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

              • ivosidenib

                ivosidenib will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2C9 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

              • labetalol

                carvedilol and labetalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • lasmiditan

                lasmiditan increases levels of carvedilol by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • lofexidine

                lofexidine, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              • lumefantrine

                lumefantrine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • metoprolol

                carvedilol and metoprolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • nadolol

                carvedilol and nadolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • nebivolol

                carvedilol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • paroxetine

                paroxetine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • penbutolol

                carvedilol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • pindolol

                carvedilol and pindolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • pomalidomide

                carvedilol increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • propranolol

                carvedilol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • quinidine

                quinidine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • rimegepant

                carvedilol will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • riociguat

                carvedilol will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

              • sotalol

                carvedilol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • sotorasib

                sotorasib will decrease the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

              • talazoparib

                carvedilol will increase the level or effect of talazoparib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration with certain P-gp inhibitors (ie, amiodarone, carvedilol, clarithromycin, itraconazole, verapamil) cannot be avoided, reduce talazoparib dose to 0.75 mg qDay. Once P-gp inhibitors are discontinued, increase talazoparib dose (after 3-5 half-lives of the inhibitor) to dose used prior to initiating the P-gp inhibitor(s).

              • tepotinib

                tepotinib will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

              • thioridazine

                carvedilol, thioridazine. Either increases levels of the other by decreasing metabolism. Contraindicated. Not all beta blockers share this interaction (e.g., atenolol, nadolol, sotalol do not interact).

              • thiothixene

                carvedilol, thiothixene. Either increases levels of the other by decreasing metabolism. Contraindicated. Not all beta blockers share this interaction (e.g., atenolol, nadolol, sotalol do not interact).

              • timolol

                carvedilol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • topotecan

                carvedilol will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

              • umeclidinium bromide/vilanterol inhaled

                carvedilol, umeclidinium bromide/vilanterol inhaled. pharmacodynamic antagonism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .

              • venetoclax

                carvedilol will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

              • vilanterol/fluticasone furoate inhaled

                carvedilol, vilanterol/fluticasone furoate inhaled. pharmacodynamic antagonism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .

              Monitor Closely (247)

              • abiraterone

                abiraterone increases levels of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

              • acebutolol

                acebutolol and carvedilol both increase serum potassium. Use Caution/Monitor.

              • aceclofenac

                carvedilol and aceclofenac both increase serum potassium. Use Caution/Monitor.

                aceclofenac decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • acemetacin

                carvedilol and acemetacin both increase serum potassium. Use Caution/Monitor.

                acemetacin decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • albuterol

                carvedilol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • aldesleukin

                aldesleukin increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • alfuzosin

                alfuzosin and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • aluminum hydroxide

                aluminum hydroxide decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • amifostine

                amifostine, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • amiloride

                carvedilol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.

              • amiodarone

                amiodarone will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                amiodarone will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Monitor for signs of bradycardia or heart block when amiodarone and a beta adrenergic blocker are coadministered. Amiodarone should be used with caution in patients receiving a beta adrenergic blocker, particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.

                amiodarone, carvedilol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.

              • amlodipine

                carvedilol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • amobarbital

                amobarbital will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                amobarbital decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • apalutamide

                apalutamide will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Coadministration of apalutamide, a weak CYP2C9 inducer, with drugs that are CYP2C9 substrates can result in lower exposure to these medications. Evaluate for loss of therapeutic effect if medication must be coadministered.

                apalutamide will decrease the level or effect of carvedilol by increasing elimination. Use Caution/Monitor. Apalutamide induces UGT and may decrease systemic exposure of drugs that are UGT substrates.

              • arformoterol

                carvedilol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • asenapine

                asenapine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                asenapine and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • aspirin

                carvedilol and aspirin both increase serum potassium. Use Caution/Monitor.

                aspirin decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • aspirin rectal

                carvedilol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

                aspirin rectal decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                carvedilol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

              • atazanavir

                atazanavir increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension, bradycardia, AV block, and prolonged PR interval. Consider lowering beta blocker dose.

              • atenolol

                atenolol and carvedilol both increase serum potassium. Use Caution/Monitor.

              • avanafil

                avanafil increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • bendroflumethiazide

                carvedilol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • berotralstat

                carvedilol increases levels of berotralstat by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduced berotralstat dose to 110 mg/day when coadministered with P-gp inhibitors.

                berotralstat will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

              • betaxolol

                betaxolol and carvedilol both increase serum potassium. Use Caution/Monitor.

              • betrixaban

                carvedilol increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

              • bismuth subsalicylate

                bismuth subsalicylate, carvedilol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.

              • bisoprolol

                bisoprolol and carvedilol both increase serum potassium. Use Caution/Monitor.

              • bosentan

                bosentan will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • bosutinib

                bosutinib increases levels of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • bretylium

                carvedilol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

              • bumetanide

                carvedilol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bupropion

                bupropion will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • butabarbital

                butabarbital will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                butabarbital decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • butalbital

                butalbital will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                butalbital decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • calcium acetate

                calcium acetate decreases effects of carvedilol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium carbonate

                calcium carbonate decreases effects of carvedilol by unspecified interaction mechanism. Use Caution/Monitor.

                calcium carbonate decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • calcium chloride

                calcium chloride decreases effects of carvedilol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium citrate

                calcium citrate decreases effects of carvedilol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium gluconate

                calcium gluconate decreases effects of carvedilol by unspecified interaction mechanism. Use Caution/Monitor.

              • candesartan

                candesartan and carvedilol both increase serum potassium. Use Caution/Monitor.

                carvedilol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • cannabidiol

                cannabidiol will increase the level or effect of carvedilol by decreasing metabolism. Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit CYP2C9 activity. Consider reducing the dose when concomitantly using CYP2C9 substrates.

              • carbamazepine

                carbamazepine will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • carbenoxolone

                carvedilol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carbidopa

                carbidopa increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              • celecoxib

                celecoxib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                carvedilol and celecoxib both increase serum potassium. Use Caution/Monitor.

                celecoxib decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • celiprolol

                carvedilol and celiprolol both increase serum potassium. Use Caution/Monitor.

              • ceritinib

                carvedilol increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • chloroquine

                chloroquine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • chlorothiazide

                carvedilol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorthalidone

                carvedilol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • choline magnesium trisalicylate

                carvedilol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.

                choline magnesium trisalicylate decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • cimetidine

                cimetidine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                cimetidine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • citalopram

                citalopram increases levels of carvedilol by decreasing metabolism. Use Caution/Monitor.

              • clevidipine

                carvedilol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • clobazam

                clobazam will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.

              • cobicistat

                cobicistat will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • crizotinib

                crizotinib increases levels of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • cyclopenthiazide

                carvedilol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dabigatran

                carvedilol will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

              • darifenacin

                darifenacin will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • darunavir

                darunavir will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • desflurane

                desflurane, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • desvenlafaxine

                desvenlafaxine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

              • dichlorphenamide

                dichlorphenamide and carvedilol both decrease serum potassium. Use Caution/Monitor.

              • diclofenac

                carvedilol and diclofenac both increase serum potassium. Use Caution/Monitor.

                diclofenac decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • diflunisal

                carvedilol and diflunisal both increase serum potassium. Use Caution/Monitor.

                diflunisal decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • digoxin

                carvedilol and digoxin both increase serum potassium. Use Caution/Monitor.

                carvedilol increases levels of digoxin by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                carvedilol increases levels of digoxin by decreasing renal clearance. Use Caution/Monitor.

                carvedilol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

              • diltiazem

                carvedilol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • diphenhydramine

                diphenhydramine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • dobutamine

                carvedilol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor.

              • dopexamine

                carvedilol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor.

              • doxazosin

                doxazosin and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • dronedarone

                dronedarone will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • drospirenone

                carvedilol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.

              • duvelisib

                carvedilol will increase the level or effect of duvelisib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • elagolix

                elagolix will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • eliglustat

                eliglustat increases levels of carvedilol by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

                eliglustat increases levels of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

                elvitegravir/cobicistat/emtricitabine/tenofovir DF decreases levels of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Elvitegravir is a moderate CYP2C9 inducer.

              • ephedrine

                carvedilol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • epinephrine

                carvedilol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • epinephrine racemic

                carvedilol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor.

              • eprosartan

                eprosartan and carvedilol both increase serum potassium. Use Caution/Monitor.

                carvedilol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • esmolol

                carvedilol and esmolol both increase serum potassium. Use Caution/Monitor.

              • ethacrynic acid

                carvedilol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ethanol

                ethanol increases levels of carvedilol by Other (see comment). Use Caution/Monitor. Comment: ETOH may affect the release rate of extended-release carvedilol (Coreg CR), resulting in higher peak plasma concentration. Separate by 2 hr. Immediate-release carvedilol (Coreg) not affected.

              • ether

                carvedilol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.

              • etodolac

                carvedilol and etodolac both increase serum potassium. Use Caution/Monitor.

                etodolac decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • etomidate

                etomidate, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • etravirine

                etravirine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • fedratinib

                fedratinib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

              • felbamate

                felbamate will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • felodipine

                carvedilol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • fenbufen

                carvedilol and fenbufen both increase serum potassium. Use Caution/Monitor.

              • fenoprofen

                carvedilol and fenoprofen both increase serum potassium. Use Caution/Monitor.

                fenoprofen decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • fingolimod

                carvedilol increases effects of fingolimod by pharmacodynamic synergism. Use Caution/Monitor. Both medications decrease heart rate. Monitor patients on concomitant therapy, particularly in the first 6 hours after fingolimod is initiated or after a treatment interruption of at least two weeks, for bradycardia and atrioventricular block. To identify underlying risk factors of bradycardia and AV block, obtain a new or recent ECG in patients using beta-blockers prior to starting fingolimod.

              • fluconazole

                fluconazole will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • fluoxetine

                fluoxetine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • flurbiprofen

                carvedilol and flurbiprofen both increase serum potassium. Use Caution/Monitor.

                flurbiprofen decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • fluvoxamine

                fluvoxamine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • formoterol

                carvedilol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • fostamatinib

                fostamatinib will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

              • furosemide

                carvedilol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • gentamicin

                carvedilol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glecaprevir/pibrentasvir

                carvedilol will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                glecaprevir/pibrentasvir will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • glucagon

                glucagon decreases toxicity of carvedilol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

              • glucagon intranasal

                glucagon intranasal decreases toxicity of carvedilol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

              • haloperidol

                haloperidol will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • hydralazine

                hydralazine increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                carvedilol increases effects of hydralazine by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • hydrochlorothiazide

                carvedilol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ibuprofen

                carvedilol and ibuprofen both increase serum potassium. Use Caution/Monitor.

                ibuprofen decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ibuprofen IV

                ibuprofen IV decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                carvedilol and ibuprofen IV both increase serum potassium. Use Caution/Monitor.

              • imatinib

                imatinib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                imatinib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • indapamide

                carvedilol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • indomethacin

                carvedilol and indomethacin both increase serum potassium. Use Caution/Monitor.

                indomethacin decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • insulin degludec

                carvedilol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • insulin degludec/insulin aspart

                carvedilol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • insulin inhaled

                carvedilol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • iodixanol

                carvedilol increases toxicity of iodixanol by unspecified interaction mechanism. Use Caution/Monitor. Use of beta-blockers lowers the threshold for and increases the severity of contrast reactions, and reduces the responsiveness of treatment of hypersensitivity reactions with epinephrine. .

              • irbesartan

                irbesartan and carvedilol both increase serum potassium. Use Caution/Monitor.

                carvedilol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • isoproterenol

                carvedilol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

              • isradipine

                carvedilol and isradipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • istradefylline

                istradefylline will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

              • ivabradine

                ivabradine, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

              • ivacaftor

                ivacaftor increases levels of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

              • ketamine

                ketamine, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • ketoconazole

                ketoconazole will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • ketoprofen

                carvedilol and ketoprofen both increase serum potassium. Use Caution/Monitor.

                ketoprofen decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ketorolac

                carvedilol and ketorolac both increase serum potassium. Use Caution/Monitor.

                ketorolac decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ketorolac intranasal

                carvedilol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • labetalol

                carvedilol and labetalol both increase serum potassium. Use Caution/Monitor.

              • lasmiditan

                carvedilol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.

              • leflunomide

                leflunomide will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • levalbuterol

                carvedilol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • levodopa

                levodopa increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              • lomitapide

                lomitapide increases levels of carvedilol by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.

              • lorcaserin

                lorcaserin will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • lornoxicam

                carvedilol and lornoxicam both increase serum potassium. Use Caution/Monitor.

                lornoxicam decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • losartan

                losartan and carvedilol both increase serum potassium. Use Caution/Monitor.

                carvedilol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • lumacaftor/ivacaftor

                lumacaftor/ivacaftor, carvedilol. affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C9 substrates. .

              • lurasidone

                lurasidone increases effects of carvedilol by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

              • maraviroc

                maraviroc will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • marijuana

                marijuana will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • meclofenamate

                meclofenamate decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                carvedilol and meclofenamate both increase serum potassium. Use Caution/Monitor.

              • mefenamic acid

                carvedilol and mefenamic acid both increase serum potassium. Use Caution/Monitor.

                mefenamic acid decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • mefloquine

                mefloquine increases levels of carvedilol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

              • meloxicam

                carvedilol and meloxicam both increase serum potassium. Use Caution/Monitor.

                meloxicam decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • metaproterenol

                carvedilol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

              • methyclothiazide

                carvedilol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • metolazone

                carvedilol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • metoprolol

                carvedilol and metoprolol both increase serum potassium. Use Caution/Monitor.

              • metronidazole

                metronidazole will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • miconazole vaginal

                miconazole vaginal will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • mirabegron

                mirabegron will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • moxisylyte

                moxisylyte and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • nabumetone

                carvedilol and nabumetone both increase serum potassium. Use Caution/Monitor.

                nabumetone decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • nadolol

                carvedilol and nadolol both increase serum potassium. Use Caution/Monitor.

              • naldemedine

                carvedilol increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

              • naproxen

                carvedilol and naproxen both increase serum potassium. Use Caution/Monitor.

                naproxen decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • nateglinide

                nateglinide will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • nebivolol

                carvedilol and nebivolol both increase serum potassium. Use Caution/Monitor.

              • nicardipine

                carvedilol and nicardipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • nifedipine

                carvedilol and nifedipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • nilotinib

                nilotinib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                nilotinib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • nintedanib

                carvedilol increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy.

              • nisoldipine

                carvedilol and nisoldipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • nitisinone

                nitisinone will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Nitisinone inhibits CYP2C9. Caution if CYP2C9 substrate coadministered, particularly those with a narrow therapeutic index.

              • nitroglycerin rectal

                nitroglycerin rectal, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.

              • norepinephrine

                carvedilol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • olmesartan

                olmesartan and carvedilol both increase serum potassium. Use Caution/Monitor.

                carvedilol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • olodaterol inhaled

                carvedilol, olodaterol inhaled. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor. Beta-blockers and olodaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

              • oxaprozin

                carvedilol and oxaprozin both increase serum potassium. Use Caution/Monitor.

                oxaprozin decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • oxymetazoline topical

                oxymetazoline topical increases and carvedilol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • parecoxib

                parecoxib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                carvedilol and parecoxib both increase serum potassium. Use Caution/Monitor.

                parecoxib decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • penbutolol

                carvedilol and penbutolol both increase serum potassium. Use Caution/Monitor.

              • pentobarbital

                pentobarbital will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                pentobarbital decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • perphenazine

                perphenazine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • phenobarbital

                phenobarbital will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                phenobarbital decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • phenoxybenzamine

                phenoxybenzamine and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • phentolamine

                phentolamine and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • pindolol

                carvedilol and pindolol both increase serum potassium. Use Caution/Monitor.

              • pirbuterol

                carvedilol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • piroxicam

                carvedilol and piroxicam both increase serum potassium. Use Caution/Monitor.

                piroxicam decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ponatinib

                ponatinib increases levels of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ponesimod

                ponesimod and carvedilol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

              • potassium acid phosphate

                carvedilol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

              • potassium chloride

                carvedilol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

              • potassium citrate

                carvedilol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.

              • prazosin

                prazosin and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • primidone

                primidone will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                primidone decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • propafenone

                propafenone will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • propofol

                propofol, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • propranolol

                carvedilol and propranolol both increase serum potassium. Use Caution/Monitor.

              • quinacrine

                quinacrine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • ranolazine

                ranolazine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • rifabutin

                rifabutin decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor.

              • rifampin

                rifampin will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                rifampin decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor.

              • rifapentine

                rifapentine will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                rifapentine decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor.

              • rifaximin

                carvedilol increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ritonavir

                ritonavir will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • rolapitant

                rolapitant will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

              • rucaparib

                rucaparib will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C9 substrates, if clinically indicated.

              • sacubitril/valsartan

                sacubitril/valsartan and carvedilol both increase serum potassium. Use Caution/Monitor.

                carvedilol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • salicylates (non-asa)

                carvedilol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

                salicylates (non-asa) decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • salmeterol

                carvedilol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • salsalate

                carvedilol and salsalate both increase serum potassium. Use Caution/Monitor.

                salsalate decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • saquinavir

                saquinavir, carvedilol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of PR prolongation and cardiac arrhythmias.

              • sarecycline

                sarecycline will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

              • secobarbital

                secobarbital will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

                secobarbital decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • sertraline

                sertraline will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • sevoflurane

                sevoflurane, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • sildenafil

                carvedilol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.

              • silodosin

                silodosin and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • siponimod

                siponimod, carvedilol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.

              • sodium bicarbonate

                sodium bicarbonate decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • sodium citrate/citric acid

                sodium citrate/citric acid decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • sotalol

                carvedilol and sotalol both increase serum potassium. Use Caution/Monitor.

              • spironolactone

                carvedilol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • stiripentol

                stiripentol will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

              • succinylcholine

                carvedilol and succinylcholine both increase serum potassium. Use Caution/Monitor.

              • sulfamethoxazole

                sulfamethoxazole will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • sulfasalazine

                carvedilol and sulfasalazine both increase serum potassium. Use Caution/Monitor.

                sulfasalazine decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • sulindac

                carvedilol and sulindac both increase serum potassium. Use Caution/Monitor.

                sulindac decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tadalafil

                tadalafil increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • telmisartan

                telmisartan and carvedilol both increase serum potassium. Use Caution/Monitor.

                carvedilol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • terazosin

                terazosin and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • terbinafine

                terbinafine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

              • terbutaline

                carvedilol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor.

              • theophylline

                carvedilol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.

              • thioridazine

                thioridazine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • ticlopidine

                ticlopidine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • timolol

                carvedilol and timolol both increase serum potassium. Use Caution/Monitor.

              • tipranavir

                tipranavir will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • tolfenamic acid

                carvedilol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.

                tolfenamic acid decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tolmetin

                carvedilol and tolmetin both increase serum potassium. Use Caution/Monitor.

                tolmetin decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tolvaptan

                carvedilol and tolvaptan both increase serum potassium. Use Caution/Monitor.

              • torsemide

                carvedilol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • triamterene

                carvedilol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.

              • tucatinib

                tucatinib will increase the level or effect of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

              • valproic acid

                valproic acid will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • valsartan

                valsartan and carvedilol both increase serum potassium. Use Caution/Monitor.

                carvedilol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • vemurafenib

                vemurafenib increases levels of carvedilol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • venlafaxine

                venlafaxine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • verapamil

                carvedilol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • voriconazole

                voriconazole will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              • xipamide

                xipamide increases effects of carvedilol by pharmacodynamic synergism. Use Caution/Monitor.

              • zafirlukast

                zafirlukast will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              Minor (31)

              • adenosine

                carvedilol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • agrimony

                agrimony increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • brimonidine

                brimonidine increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • cevimeline

                cevimeline increases effects of carvedilol by unspecified interaction mechanism. Minor/Significance Unknown.

              • ciprofloxacin

                ciprofloxacin increases levels of carvedilol by decreasing metabolism. Minor/Significance Unknown. May also rarely decrease beta blocker levels.

              • cocaine

                carvedilol increases effects of cocaine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.

              • cornsilk

                cornsilk increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • dihydroergotamine

                dihydroergotamine, carvedilol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

              • dihydroergotamine intranasal

                dihydroergotamine intranasal, carvedilol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

              • dipyridamole

                dipyridamole, carvedilol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

              • duloxetine

                duloxetine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • escitalopram

                escitalopram increases levels of carvedilol by decreasing metabolism. Minor/Significance Unknown.

              • fenoldopam

                fenoldopam increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • forskolin

                forskolin increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • imaging agents (gadolinium)

                carvedilol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.

              • levobetaxolol

                levobetaxolol increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • maitake

                maitake increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • melatonin

                melatonin decreases toxicity of carvedilol by pharmacodynamic antagonism. Minor/Significance Unknown. Melatonin may correct beta blocker induced sleep disturbances.

              • metipranolol ophthalmic

                metipranolol ophthalmic increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • neostigmine

                carvedilol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • noni juice

                carvedilol and noni juice both increase serum potassium. Minor/Significance Unknown.

              • octacosanol

                octacosanol increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • omeprazole

                omeprazole will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.

              • physostigmine

                carvedilol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • pilocarpine

                pilocarpine increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • reishi

                reishi increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • shepherd's purse

                shepherd's purse, carvedilol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

              • tizanidine

                tizanidine increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • treprostinil

                treprostinil increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown.

              • vardenafil

                vardenafil increases effects of carvedilol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • yohimbe

                carvedilol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Dizziness (2-32%)

              Fatigue (4-24%)

              Hypotension (9-20%)

              Weight gain (10-12%)

              Hyperglycemia (5-12%)

              Diarrhea (1-12%)

              1-10% (selected)

              Bradycardia (2-10%)

              Nausea (2-9%)

              Cough (5-8%)

              Headache (5-8%)

              Atrioventricular block, edema (1-7%)

              Angina (1-6%)

              Hpercholesterolemia (1-4%)

              Hypertriglyceredemia (1%)

              Vomiting (1-6%)

              Dyspnea (>3%)

              Syncope (3%)

              Rhinitis (2%)

              Frequency Not Defined (selected)

              Hypertension

              Palpitations

              Insomnia

              Somnolence

              Skin rash

              Hepatotoxicity

              Impotence

              Bronchospasm

              Rales

              Depression

              Decreased exercise tolerance

              Raynaud phenomenon

              Increased triglyceride levels and insulin resistance with decreased high-density lipoprotein (HDL) levels

              Postmarketing Reports

              Blood and lymphatic system: Aplastic anemia

              Immune system: Hypersensitivity (eg, anaphylactic reactions, angioedema, urticaria) with Coreg and Coreg CR, including cases occurring after initiation of Coreg CR in patients previously treated with Coreg

              Kidneys and urinary tract: Urinary incontinence

              Respiratory system, thorax, and mediastinum: Interstitial pneumonitis

              Skin and subcutaneous tissue: Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme

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              Warnings

              Contraindications

              History of serious hypersensitivity reaction (eg, Stevens-Johnson syndrome, anaphylactic reaction, angioedema) to any component of this medication or other medications containing carvedilol

              Bronchial asthma, bronchospasm

              Chronic obstructive pulmonary disease (COPD)

              2°/3° AV block, sick sinus syndrome without permanent pacemaker, cardiogenic shock, severe bradycardia, decompensated heart failure requiring IV inotropic medication

              Severe hepatic impairment

              Cautions

              Use cautioin in anesthesia or surgery (myocardial depression), cerebrovascular insufficiency, diabetes mellitus, hyperthyroidism or thyrotoxicosis, liver disease, peripheral vascular disease (monitor for progression of arterial obstruction), compromised left ventricular function, heart failure, pheochromocytoma, and myasthenia gravis

              Avoid beta-blocker use in non-allergic bronchospasm (e.g., chronic bronchitis and emphysema); if deemed necessary, use with caution and at lowest effective dose

              Combined incidence of hypotension, syncope, or dizziness reported in elderly patients (>65 years) switched from highest dose of immediate-release carvedilol (25 mg q12hr) to extended-release carvedilol 80 mg/day

              When elderly patients are switched from higher doses of immediate-release carvedilol to extended-release carvedilol, a lower starting dose is recommended

              Sudden discontinuance can exacerbate angina and lead to myocardial infarction

              Increased risk of stroke after surgery

              Dosage should be reduced if bradycardia (HR <55 beats/min) develops

              May mask hypoglycemia or hyperthyroidism

              May worsen arterial insufficiency in patients with peripheral vascular disease

              Use caution in patients with mild to moderate hepatic impairment

              Heart failure patients may experience a worsening of renal function, especially during upward titration; dose reduction or temporary discontinuation may be necessary; may also need to adjust other medications

              Extended release: Separate any form of alcohol intake by at least 2 hours

              Elderly (liver function)

              Intraoperative floppy iris syndrome observed during cataract surgery in some patients treated with alpha1-blocking agents

              Beta-blockers may cause induction or exacerbation of psoriasis

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              Pregnancy & Lactation

              Pregnancy

              Available data in pregnant women are insufficient to determine whether there are drug-associated risks of adverse developmental outcomes; there are risks to mother and fetus associated with poorly controlled hypertension in pregnancy; the use of beta blockers during third trimester of pregnancy may increase risk of hypotension, bradycardia, hypoglycemia, and respiratory depression in neonates; in animal reproduction studies, there was no evidence of adverse developmental outcomes at clinically relevant doses; observe newborns for symptoms of hypotension, bradycardia, hypoglycemia, and respiratory depression and manage accordingly

              Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (e.g., need for cesarean section and post-partum hemorrhage); hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly

              Lactation

              There are no data on presence of carvedilol in human milk, effects on breastfed infant, or on milk production; drug is present in the milk of lactating rats; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from treatment or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Nonselective beta-adrenergic and alpha1-adrenergic blocking agent with no intrinsic activity for use in congestive heart failure and hypertension

              Absorption

              Bioavailability: 25-35% (immediate release)

              Onset (antihypertensive): Initial response, 1 hr; peak response, 1-2 hr

              Duration: 24 hr

              Peak plasma time: 5 hr

              Distribution

              Protein bound: >98%

              Vd: 115-132 L

              Metabolism

              Metabolized by CYP2D6 and CYP2C9 and, to a lesser extent, by CYP3A4, 2C19, 1A2, and 2E1

              Metabolites: 4'-Hydroxyphenyl metabolite is approximately 13 times more potent than carvedilol for beta blockade

              Elimination

              Half-life: 7-10 hr

              Dialyzable: HD, no

              Excretion: Feces (60%), urine (16%)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Coreg oral
              -
              25 mg tablet
              Coreg oral
              -
              6.25 mg tablet
              Coreg oral
              -
              12.5 mg tablet
              Coreg oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              12.5 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              25 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              3.125 mg tablet
              carvedilol oral
              -
              6.25 mg tablet
              carvedilol oral
              -
              6.25 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              carvedilol oral

              CARVEDILOL - ORAL

              (KAR-ve-DIL-ol)

              COMMON BRAND NAME(S): Coreg

              WARNING: Do not stop taking this medication without consulting your doctor. Some conditions may become worse when you suddenly stop this drug. Some people who have suddenly stopped taking similar drugs have had chest pain, heart attack, and irregular heartbeat. If your doctor decides you should no longer use this drug, your doctor may direct you to gradually decrease your dose over 1 to 2 weeks.When gradually stopping this medication, it is recommended that you temporarily limit physical activity to decrease strain on the heart. Get medical help right away if you develop chest pain/tightness/pressure, chest pain spreading to the jaw/neck/arm, unusual sweating, trouble breathing, or fast/irregular heartbeat.

              USES: Carvedilol is used to treat high blood pressure and heart failure. It is also used after a heart attack to improve the chance of survival if your heart is not pumping well. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.This drug works by blocking the action of certain natural substances in your body, such as epinephrine, on the heart and blood vessels. This effect lowers your heart rate, blood pressure, and strain on your heart. Carvedilol belongs to a class of drugs known as alpha and beta blockers.

              HOW TO USE: See also Warning section.Read the Patient Information Leaflet if available from your pharmacist before you start taking carvedilol and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with food as directed by your doctor, usually twice daily.The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.For the treatment of high blood pressure, it may take 1 to 2 weeks before you get the full benefit of this drug. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.Tell your doctor if your condition does not improve or if it worsens (for example, your blood pressure readings remain high or increase, or you have worsening symptoms of heart failure like increased shortness of breath).

              SIDE EFFECTS: See also Warning and Precautions sections.Dizziness, lightheadedness, drowsiness, diarrhea, impotence, or tiredness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. The risk of dizziness is highest within 1 hour after you take your dose. Taking this medication with food and starting treatment with a low dose and slowly increasing your dose as directed by your doctor help to reduce the risk of dizziness.This drug may reduce blood flow to your hands and feet, causing them to feel cold. Smoking may worsen this effect. Dress warmly and avoid tobacco use.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: very slow heartbeat, severe dizziness, fainting, unusual weakness, signs of kidney problems (such as change in the amount of urine), numbness/tingling of the hands/feet, blue fingers/toes, easy bruising/bleeding, mental/mood changes (such as confusion, depression), seizures.Although this medication may be used to treat heart failure, some people may rarely develop new or worsening symptoms of heart failure, especially at the start of carvedilol treatment. Tell your doctor right away if you develop any of these serious side effects: shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking carvedilol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: certain types of heartbeat/heart rhythm problems (such as slow/irregular heartbeat, sick sinus syndrome, second- or third-degree atrioventricular block), breathing problems (such as asthma, chronic bronchitis, emphysema), severe heart failure requiring hospitalization, liver disease, kidney disease, blood circulation problems (such as Raynaud's disease, peripheral vascular disease), serious allergic reactions including those needing treatment with epinephrine, overactive thyroid disease (hyperthyroidism), a certain type of tumor (pheochromocytoma), other heart problems (such as Prinzmetal's variant angina), a certain muscle disease (myasthenia gravis), certain eye problems (cataracts, glaucoma).This drug may make you dizzy or drowsy or cause you to faint. This is most likely to occur within 1 hour after taking your dose, especially when you start carvedilol treatment or any time your doctor increases your dose. During these periods, avoid driving and doing hazardous tasks. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).People who wear contact lenses may have dry eyes while taking this medication.Before having surgery (including cataract/glaucoma eye surgery), tell your doctor or dentist if you are taking or have ever taken this medication, and about all the other products you use (including prescription drugs, nonprescription drugs, and herbal products).If you have diabetes, this product may mask the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness and sweating, are unaffected by this drug. This product may also make it harder to control your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet.Children may be at greater risk for low blood sugar (hypoglycemia), especially if they are vomiting or not eating regularly. To help prevent low blood sugar, feed children on a regular schedule. If your child cannot eat regularly, is vomiting, or has symptoms of low blood sugar (such as sweating, seizures), stop this medication and tell the doctor right away.Older adults may be more sensitive to the side effects of this drug, especially dizziness and lightheadedness.This medication is not recommended for use during pregnancy. It may harm an unborn baby. Consult your doctor for more details.It is unknown if carvedilol passes into breast milk. However, it is unlikely to pass into breast milk in large amounts. There is a low risk that it may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.One product that may interact with this drug is: fingolimod.Some products have ingredients that could raise your heart rate or blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: very slow heartbeat, severe dizziness, fainting, slow/shallow breathing, seizures.

              NOTES: Do not share this medication with others.Lifestyle changes that may help this medication work better include exercising, stopping smoking, and eating a low-cholesterol/low-fat diet. Consult your doctor for more details.Have your blood pressure and pulse (heart rate) checked regularly while taking this medication. Learn how to monitor your own blood pressure and pulse at home, and share the results with your doctor.Laboratory and/or medical tests (such as kidney and liver function tests) should be performed periodically to monitor your progress or check for side effects.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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              • View the formulary and any restrictions for each plan.
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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.