Dilatrend

Carvedilol

Management of essential HTN, can be used alone or in combination w/ other antihypertensive agents (eg, thiazide-type diuretics). Treatment of angina pectoris. Treatment of stable chronic heart failure of all degrees of severity (ischemic or non-ischemic in origin), as an adjunct to treatment w/ diuretics, ACE inhibitors & optionally digitalis.

Essential HTN Initially 12.5 mg once daily for the 1st 2 days. Thereafter, 25 mg once daily. May be increased at intervals of at least 2 wk to max 50 mg once daily or in divided doses (bd). Elderly Initially 12.5 mg once daily, may be titrated at intervals of at least 2 wk up to max 50 mg once daily or in divided doses. Angina pectoris Initially 12.5 mg bd for the 1st 2 days. Thereafter, 25 mg bd. Thereafter, may be increased at intervals of at least 2 wk up to max 100 mg daily, given in divided doses (bd). Elderly Max 50 mg daily, given in divided doses (bd). Stable chronic heart failure Initially 3.125 mg bd for 2 wk. If tolerated, may be increased at intervals of not less than 2 wk to 6.25 mg, 12.5 mg & 25 mg bd. Max: 25 mg bd for patients w/ severe chronic heart failure & patients w/ mild to moderate chronic heart failure weighing <85 kg (187 lbs); 50 mg bd for patients w/ mild or moderate chronic heart failure weighing >85 kg.

Should be taken with food.

Hypersensitivity. Unstable/decompensated heart failure; clinically manifest liver dysfunction; 2nd & 3rd degree AV block (unless a permanent pacemaker is in place); severe bradycardia (<50 bpm); sick sinus syndrome (including SA block); severe hypotension (systolic BP <85 mmHg); cardiogenic shock; history of bronchospasm or asthma.

Risk of worsening cardiac failure or fluid retention during up-titration of carvedilol in congestive heart failure patients; reversible deterioration of renal function in chronic heart failure patients w/ low BP (systolic BP <100 mmHg), ischaemic heart disease & diffuse vascular disease, &/or underlying renal insufficiency. Caution in patients w/ COPD w/ bronchospastic component who are not receiving oral or inhaled medication; DM patients; patients w/ peripheral vascular disease; patients suffering from peripheral circulatory disorders (eg, Raynaud's phenomenon); patients undergoing general surgery; patients w/ history of serious hypersensitivity reactions & undergoing desensitisation therapy; history of psoriasis associated w/ β-blocker; patients suspected of having pheochromocytoma; Prinzmetal's variant angina. May obscure symptoms of thyrotoxicosis. May induce bradycardia. Wearers of contact lenses should bear in mind the possibility of reduced lacrimation. Do not discontinue abruptly, particularly in patients w/ ischaemic heart disease. Use w/ caution in combination w/ digitalis glycosides. Careful monitoring of ECG & BP in patients receiving concomitant therapy w/ Ca channel blockers of verapamil or diltiazem type or other antiarrhythmic drugs. Ability to drive, operate machinery, or work w/o firm support may be impaired. Pregnancy. Not recommended if breast-feeding.

Chronic heart failure: Dizziness, headaches; asthenia (including fatigue). Bradycardia, postural hypotension, hypotension, oedema (including generalised, peripheral, dependent & genital oedema, oedema of the legs, hypervolaemia & fluid overload); nausea, diarrhoea, vomiting; wt increase & hypercholesterolemia; hyperglycaemia, hypoglycaemia, worsening control of blood glucose in patients w/ pre-existing DM; vision abnormalities. Essential HTN & long-term management of coronary heart disease: Dizziness, headaches, fatigue; bradycardia, postural hypotension; asthma & dyspnea in predisposed patients; GI upset (w/ symptoms eg, nausea, abdominal pain, diarrhoea); pain in the extremities; reduced lacrimation & eye irritation.

Increased bioavailability of P-glycoprotein substrates. Modified bioavailability w/ P-glycoprotein inducers or inhibitors. Modified systemic &/or presystemic metabolism w/ CYP2D6 & CYP2C9 inhibitors or inducers. Increased conc of digoxin; cyclosporin (oral). Decreased plasma levels w/ rifampicin. Decreased clearance of S-carvedilol w/ amiodarone. Increased mean AUC of R-carvedilol w/ fluoxetine. May enhance blood-sugar-reducing effect of insulin & oral hypoglycaemics. Risk of hypotension &/or severe bradycardia w/ catecholamine-depleting agents (eg, reserpine & MAOIs). Additive prolongation of AV conduction time w/ digoxin. Increased risk of AV conduction disturbances w/ verapamil, diltiazem, amiodarone or other antiarrhythmics. Potentiated BP- & heart rate-lowering effects w/ clonidine. Isolated cases of conduction disturbance w/ diltiazem. May potentiate effect of other antihypertensives (eg, α₁-receptor antagonists) or drugs that have hypotension as part of their adverse effect profile. Synergistic negative inotropic & hypotensive effects w/ anaesth. Increased BP & lowered BP control w/ NSAIDs. Opposed bronchodilator effects of β-agonist bronchodilators.

Beta-Blockers

C07AG02 - carvedilol ; Belongs to the class of alpha and beta blocking agents. Used in the treatment of cardiovascular diseases.

P₁S₁S₃