Karvil 6.25/Karvil 12.5/Karvil 25

Management of essential HTN & angina pectoris. As adjunct to standard therapy in symptomatic heart failure.

HTN Initially 6.25 mg bid for 7-14 days, then increase to 12.5 mg bid. May further increase, if necessary, at intervals of at least 2 wk, to 50 mg once daily or in divided doses. Elderly 12.5 mg once daily. Heart failure Initially 3.125 mg bid. If tolerated, dose should be doubled after 2 wk to 6.25 mg bid. Gradually increase at intervals of not <2 wk to max dose tolerated. Patient w/ mild to moderate heart failure weighing >85 kg Max dose: 50 mg bid, severe heart failure or those weighing <85 kg Max dose: 25 mg bid. Angina pectoris Initially 12.5 mg bid. Increase after 2 days to 25 mg bid. Left ventricular dysfunction following MI Initially 6.25 mg bid. If tolerated, increase after 3-10 days to 12.5 mg bid & then to a target dose of 25 mg bid.

Should be taken with food: Reduced risk of hypotension if taken w/ food.

Hypersensitivity. Patients w/ NYHA class IV decompensated cardiac failure requiring IV inotropic therapy, bronchial asthma or related bronchospastic conditions, 2nd or 3rd degree AV block, sick sinus syndrome (unless permanent pacemaker is in place), cardiogenic shock or severe bradycardia. Not recommended in patients w/ clinically manifested hepatic impairment.

Can precipitate or aggravate symptoms of arterial insufficiency in patients w/ peripheral vascular disease. Caution when used w/ anesth agents if treatment is to be continued pre-op. May mask manifestations of hypoglycemia particularly tachycardia. May mask clinical signs of hyperthyroidism eg, tachycardia. Do not discontinue abruptly in patients w/ ischemic heart disease. May induce bradycardia. Use lower starting dose to decrease risk of syncope or hypotension. Worsening of cardiac failure or fluid retention may occur during dose up-titration. May lead to worsening hyperglycemia in CHF patients w/ diabetes. β-blockers may increase both sensitivity towards allergens & seriousness of anaphylactic reactions. Carefully monitor ECG & BP in patients receiving concomitant therapy w/ Ca channel blockers of the verapamil or diltiazem type or other antiarrhythmic drugs. Possibility of reduced lacrimation in wearers of contact lenses. Patients w/ history of serious hypersensitivity reactions & those undergoing desensitization therapy; patients w/ COPD w/ a bronchospastic component who are not receiving oral or inhaled medication; patients w/ tendency to bronchospasm; history of psoriasis; suspected pheochromocytoma; suspected Prinzmetal's variant angina. Avoid driving or hazardous tasks during initiation of therapy. Treatment should be stopped & not restarted if patient has lab evidence of liver injury or jaundice. Pregnancy & lactation. Reduced placental perfusion w/ β-blockers. Risk of cardiac & pulmonary complications in neonate in postnatal period.

Postural hypotension, dizziness & headache; dyspnea, bronchospasm, bradycardia, malaise & asthenia. Hyperuricemia, hypoglycemia, hyponatremia, increased alkaline phosphatase, glycosuria, somnolence, impotence, abnormal renal function & albuminuria.

Hypotensive effects may be potentiated w/ general anesth & anesth that cause myocardial depression eg, ether, cyclopropane & trichloroethylene. Can precipitate bradycardia & heart block w/ antiarrhythmic drugs & other drugs affecting cardiac conduction. Reduced plasma conc w/ rifampicin. Increased plasma conc w/ fluoxetine. Enhanced antihypertensive effect w/ other antihypertensive drugs. Can potentiate severe orthostatic hypotension following initial dose of prazosin. Can exacerbate rebound HTN following w/drawal of clonidine. Hypotension, bradycardia, conduction defect & heart failure w/ Ca channel blockers. Increased plasma conc of digoxin & cyclosporin.

Beta-Blockers

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

Rx