Carvid

Management of essential HTN alone or in combination w/ other antihypertensives. Mild to severe chronic heart failure of ischemic or cardiomyopathic origin in combination w/ diuretics, ACE inhibitors, & digitalis to increase survival & decrease risk of hospitalization. Decreases CV mortality in clinically stable patients who have survived acute phase of MI & have a left ventricular ejection fraction of ≥40% (w/ or w/o symptomatic heart failure). Prophylactic treatment of stable angina.

HTN Initially 12.5 mg once daily or 6.25 mg bid. Thereafter, recommended dose is 25 mg once daily or 12.5 mg bid. Dose may be increased at intervals of at least 2 wk to max of 50 mg given once daily or in divided doses (bid). Angina pectoris Adult Initially 12.5 mg bid for the 1st 2 days. Thereafter, recommended dose is 25 mg bid. Dose may be increased at intervals of at least 2 wk to max of 100 mg in divided doses (bid). Elderly 50 mg in divided doses (bid). Symptomatic, stable chronic heart failure Initially 3.125 mg bid for 2 wk. If dose is tolerated, increase to 6.25 mg bid, followed by 12.5 mg bid & thereafter 25 mg bid, at intervals of not <2 wk. Max: 25 mg bid in patient w/ severe heart failure & w/ mild to moderate heart failure <85 kg, or 50 mg bid in patient w/ mild to moderate heart failure >85 kg. Left ventricular dysfunction following MI 1st dose: Initially 6.25 mg, increased to 6.25 mg bid & maintained for 3-10 days. Decrease dose to 3.125 mg bid if patient develops signs of tolerance. If well tolerated, increase dose to 6.25 mg bid after 3-10 days & if further well tolerated, increase dose at intervals of 3-10 days to 12.5 mg bid & then 25 mg bid. Max: 25 mg bid.

Should be taken with food: Take w/ food to slow rate of absorption & reduce incidence of orthostatic effects.

Hypersensitivity. Unstable/decompensated heart failure; marked fluid retention or overload requiring IV inotropic support; 2nd or 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; metabolic acidosis; history of bronchospasm or asthma, or other obstructive lung disorders. Clinically manifest hepatic impairment.

Risk of anaphylactic reaction. Discontinue use in case of lab evidence of liver injury or jaundice. Not to be given in patients w/ bronchospastic disease eg, chronic bronchitis & emphysema. Worsening heart failure or fluid retention may occur. May mask clinical signs of hyperthyroidism eg, tachycardia. Possibility of reduced lacrimation in wearers of contact lenses. Reduce dose if pulse rate drops to <55 times/min. Monitor blood glucose when dose is started, adjusted, or discontinued. Monitor renal function during up-titration & discontinue use or decrease dose if worsening of renal function occurs. Do not abruptly discontinue therapy (discontinue over 1-2 wk). Concomitant use w/ digitalis glycosides; anesth which depress myocardial function eg, ether, cyclopropane & trichloroethylene (if treatment is continued peri-op). Avoid situations (eg, driving or hazardous tasks, where injury could result) should syncope occur. Pregnancy. Not recommended during lactation. Childn <18 yr.

Asthenia, allergy, fatigue, fever, hypovolemia, malaise, edema (generalized, peripheral, dependent, genital, leg, hypervolemia, fluid overload), flu syndrome, pain in extremities; bradycardia, hypotension/postural hypotension, fluid overload, syncope (including presyncope), AV block, palpitation, angina pectoris (including chest pain), cardiac failure, HTN, peripheral ischemia, tachycardia, bundle branch block, myocardial ischemia, peripheral circulation disturbances (eg, cold extremities, peripheral vascular disorder, exacerbation of intermittent claudication, Raynaud's phenomenon); diarrhea, nausea, vomiting, melena, periodontitis, GI pain & hemorrhage, abdominal pain, bilirubinemia, dry mouth, constipation; prolonged prothrombin time, purpura, thrombocytopenia, anemia, leukopenia, pancytopenia, atypical lymphocytes, aplastic anemia (rare); hyperglycemia, hypoglycemia, hyperuricemia, hyponatremia, hypercholesterolemia, hyperkalemia, hypokalemia, hypertriglyceridemia, glycosuria, wt increase & loss, DM, gout; elevations of alkaline phosphatase, AST, ALT, γ-glutamyl transferase, BUN, non-protein nitrogen, creatinine; decreased HDL; arthralgia, arthritis, hypotonia, muscle cramps; dizziness, headache, hypesthesia, vertigo, somnolence, paresthesia, CVA, depression, hypokinesia, nervousness, sleep disorder, impaired conc, abnormal thinking, paroniria, emotional lability, cerebrovascular disorder, convulsions, migraine, neuralgia, paresis, amnesia; impotence, decreased libido; increased cough, rales, dyspnea, lung edema, asthma, bronchospasm, bronchitis, pneumonia, URTI, pulmonary edema, wheezing, stuffy nose, resp alkalosis, interstitial pneumonitis (rare); pruritus, rash (erythematous, maculopapular, psoriaform), allergic exanthema, photosensitivity & anaphylactoid reaction, increased sweating, angioedema, urticaria, exfoliative dermatitis, dermatitis, severe skin reactions including SJS, TEN, erythema multiforme (rare); abnormal or blurred vision, eye irritation, decreased lacrimation & hearing, tinnitus; abnormal renal function, renal failure, albuminuria, hematuria, increased micturition frequency, UTI, urinary incontinence in women (rare); possibility of latent DM to become manifest, manifest diabetes to be aggravated, & blood glucose counter-regulation to be inhibited.

Increased blood levels of R(+) enantiomer w/ strong CYP2D6 inhibitors eg, quinidine, fluoxetine, paroxetine, & propafenone. Signs of hypotension &/or severe bradycardia w/ drug that can deplete catecholamines eg, reserpine & MAOIs. BP- & heart rate-lowering effects may be potentiated w/ clonidine. May increase risk of bradycardia w/ digoxin. Serum levels may be decreased w/ mixed function oxidase inducers (eg, rifampicin) or increased w/ mixed function oxidase inhibitors (eg, cimetidine). Conduction disturbance (rarely w/ hemodynamic compromise) w/ diltiazem. May enhance blood sugar-reducing effect of insulin & oral hypoglycemics. Increased conc of S(-) enantiomer w/ amiodarone & its metabolite desethyl amiodarone. β-blocking properties may be increased resulting in further slowing of heart rate or cardiac conduction w/ amiodarone or other CYP2C9 inhibitors eg, fluconazole. Synergistic -ve inotropic & hypotensive effects w/ anesth. May potentiate effect of other medicines that are antihypertensive in action (eg, α1-receptor antagonists) or have hypotension as adverse effect.

Beta-Blockers

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

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