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Special care should be taken in patients whose cardiac reserve is poor. Heart failure should be satisfactorily controlled with appropriate therapy before carvedilol is started.
Although angina has not been reported on stopping treatment, withdrawal should be gradual in patients with ischaemic heart disease since carvedilol has β-blocking activity.
As with other β-blocking drugs, carvedilol may mask the symptoms of hyperthyroidism and early signs of acute hypoglycemia in patients with diabetes mellitus. Alternatives to β-blocking agents are generally preferred in insulin-dependent diabetic patients.
Effects on the Ability to Drive or Operate Machinery: As for other drugs which produce changes in blood pressure, patients taking carvedilol should be warned not to drive or operate machinery if they experience dizziness or related symptoms. This may be most relevant when starting or changing treatment and when alcohol is taken.
Use in pregnancy & lactation: There is no evidence from animal studies that carvedilol has any teratogenic effects. The relevance of these findings for humans is uncertain. Animal studies have shown that carvedilol crosses the placental barrier and is excreted in breast milk and therefore, the possibility of the consequences of α- and β-blockade in the human fetus and neonate should be borne in mind. Carvedilol, is therefore, not recommended for use during pregnancy or in breastfeeding mothers.
