Duration of treatment: Treatment with carvedilol is a long-term therapy. Treatment should not be stopped abruptly but rather gradually reduced at weekly intervals. This is particularly important in the case of patients with concomitant coronary heart disease.
Essential hypertension: The recommended dose for initiation of therapy is 12.5 mg once a day for the first 2 days. Thereafter, the recommended dosage is 25 mg once a day. If necessary, the dosage may subsequently be increased at intervals of at least two weeks to the recommended maximum daily dose of 50 mg given once daily or in divided doses (twice daily).
Angina pectoris: The recommended dose for initiation of therapy is 12.5 mg twice a day for the first 2 days. Thereafter, the recommended dosage is 25 mg twice a day. If necessary, the dosage may thereafter be increased at intervals of at least two weeks, up to the recommended maximum daily dose of 100 mg given in divided doses (twice daily).
Symptomatic, stable, chronic heart failure: Dosage must be tailored to suit the individual and closely monitored by a physician during up-titration.
For those patients receiving digitalis, diuretics and ACE inhibitors, dosing of these drugs should be stabilized before initiation of Vacodil treatment.
The recommended dose for initiation of therapy is 3.125 mg twice daily for 2 weeks. If this dose is tolerated, the dose may thereafter be increased, at intervals of not less than two weeks, to 6.25 mg, 12.5 mg and 25 mg twice daily. Doses should be increased to the highest level tolerated by the patient.
The maximum recommended dose is 25 mg twice daily for all patients with severe CHF and for patients with mild to moderate CHF weighing less than 85 kg (187 lbs) in patients with mild or moderate CHF weighing more than 85 kg; the maximum recommended dose if 50 mg twice daily.
Before each dose increase, the patient should be evaluated by the physician for symptoms of vasodilation or worsening heart failure.
Transient worsening of heart failure or fluid retention should be treated with increased doses of diuretics. Occassionally, it may be necessary to lower the dose of Vacodil and, in rare cases, temporarily discontinue Vacodil treatment.
If Vacodil treatment is discontinued for more than one week, therapy should be recommended at a lower dose level (twice daily) and up-titrated in line with the previously mentioned dosing recommendation. If Vacodil is discontinued for more than two weeks, therapy should be recommenced at 3.125 mg in line with the previously mentioned dosing recommendation.
Symptoms of vasodilation may be managed initially by a reduction in the dose of diuretics. If symptoms persist, the dose of ACE inhibitor (if used) may be reduced, followed by a reduction in the dose of carvedilol if necessary. Under these circumstances, the dose of carvedilol should not be increased until symptoms of worsening heart failure or vasodilation have been stabilized.
Special dosage instructions: Renal impairment: Available pharmacokinetic data in patients with varying degrees of renal impairment (including renal failure) suggest no changes in Vacodil dosing recommendation are warranted in patients with moderate to severe renal insufficiency.
Hepatic impairment: Vacodil is contraindicated in patients with clinical manifestations of liver dysfunction (see Contraindications).
Elderly: There is no evidence to support dose adjustment.
Method of administration: Oral.