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Hepatic injury: Mild hepatocellular injury, confirmed by rechallenge, has occurred rarely with Carvedilol therapy. If the patient has laboratory evidence of liver injury or jaundice, Carvedilol should be stopped and not restarted.
Chronic Obstructive Pulmonary Disease: Carvedilol should be used with caution in patients with chronic obstructive pulmonary disease (COPD) with a bronchospastic component who are not receiving oral or inhaled medication, and only if the potential benefit outweighs the potential risk.
In patients with a tendency to bronchospasm, respiratory distress can occur as a result of a possible in airway resistance. Patients should be closely monitored during initiation and up-titration of carvedilol and the dose of carvedilol should be reduced if any evidence of bronchospasm is observed during treatment.
Peripheral Vascular Disease: β-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. Caution should be exercised in such individuals.
Anesthesia & Major Surgery: If Carvedilol treatment is to be continued preoperatively, particular care should be taken when anesthetic agents, which depress myocardial function such as ether, cyclopropane and trichloroethylene, are used.
Diabetes & Hypoglycemia: β-blockers may mask some of the manifestations of hypoglycemia, particularly tachycardia. Patients subject to spontaneous hypoglycemia, or diabetic patients receiving insulin or oral hypoglycemic agents should be cautioned about these possibilities and Carvedilol should be used with caution in such patients.
Thyrotoxicosis: β-adrenergic blockade may mask clinical signs of hyperthyroidism, such as tachycardia. Abrupt withdrawal of β-blockade may be followed by an exacerbation of the symptoms of hyperthyroidism or may precipitate thyroid storm.
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