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Carvedilol

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  1. About carvedilol
  2. Key facts
  3. Who can and cannot take carvedilol
  4. How and when to take carvedilol
  5. Side effects
  6. How to cope with side effects of carvedilol
  7. Pregnancy and breastfeeding
  8. Cautions with other medicines
  9. Common questions about carvedilol

1. About carvedilol

Carvedilol is a beta blocker.

It’s used to treat high blood pressure (hypertension) and helps prevent:

It can also be given with other medicines to treat heart failure and to prevent chest pain caused by angina.

Carvedilol is only available on prescription. It comes as tablets.

2. Key facts

  • Carvedilol slows down your heart rate and makes it easier for your heart to pump blood around your body.
  • You’ll usually take carvedilol once or twice a day.
  • It usually starts to work after about 1 hour. But it will take days or weeks for it to reach its full effect.
  • Common side effects of carvedilol include headaches and feeling tired or dizzy.
  • Do not stop taking carvedilol suddenly. This can make your condition worse, especially if you have heart disease.

3. Who can and cannot take carvedilol

Carvedilol can be taken by most adults. It can sometimes be prescribed by a specialist for children aged 2 years and over.

Carvedilol is not suitable for some people. Tell your doctor before starting the medicine if you have:

  • ever had an allergic reaction to carvedilol or any other medicines
  • lung disease or asthma
  • heart failure that is getting worse
  • have low blood pressure (hypotension) or a slow heart rate
  • a liver problem
  • serious circulation problems in your arms and legs, such as Raynaud’s

4. How and when to take carvedilol

When you start taking carvedilol, your doctor may advise you to take your first dose just before you go to bed. This is because it can make you feel dizzy.

After the first dose, if you do not feel dizzy, you can take your medicine in the morning. If you do feel dizzy, it’s best to keep taking your medicine at bedtime.

It’s best to take carvedilol at the same time each day.

If you take it twice a day, you’ll usually have 1 dose in the morning and 1 dose in the evening. Leave 10 to 12 hours between doses if you can.

Swallow the tablets whole with a drink of water. Do not chew or crush them.

Carvedilol does not usually upset your stomach, so you can take it with or without food. However, if you are taking carvedilol for heart failure, it’s best to take the tablets with food. This will help reduce the risk of you feeling dizzy or faint when you stand up.

If you find tablets difficult to swallow, some strengths have a score line to help you break the tablet in half. Check the information leaflet that comes with your medicine to see if you can do this.

Dosage

Carvedilol tablets come in 4 different strengths – 3.125mg, 6.25mg, 12.5mg and 25mg.

How much you take depends on why you need carvedilol.

The usual starting dose to treat:

  • high blood pressure is 12.5mg once a day for 2 days – this is increased to 25mg, taken once a day. If your blood pressure does not go down enough your doctor may increase your dose to up to 50mg a day. This can be taken as a single dose or split into 2 doses.
  • heart failure is 3.125mg, taken twice a day for 2 weeks. Your doctor will then slowly increase the dose every 2 weeks up to a maximum of 25mg to 50mg (depending on your weight).
  • angina is 12.5mg, taken twice a day for 2 days – this is increased to 25mg, taken twice a day.

If your child is prescribed carvedilol, the doctor will use their weight to work out the right dose.

What if I forget to take it?

If you miss a dose of carvedilol, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

The amount of carvedilol that can lead to an overdose varies from person to person.

Taking too much carvedilol can lower your blood pressure, slow your heart rate, and make it difficult to breathe.

Urgent advice: Contact 111 for advice now if:

  • you take too much carvedilol

Call 111 or go to 111.nhs.uk

If you need advice for a child under the age of 5 years, call 111.

5. Side effects

Like all medicines, carvedilol can cause side effects in some people, but many people have no side effects or only minor ones.

Side effects usually improve as your body gets used to the medicine.

Common side effects

These common side effects may happen in more than 1 in 100 people. They’re usually mild and last a few days after starting the medicine or increasing your dose.

Talk to your doctor or pharmacist if these side effects bother you or do not go away:

  • feeling dizzy
  • headaches
  • feeling tired
  • feeling or being sick (nausea or vomiting)
  • cold fingers or toes

Serious side effects

It happens rarely, but some people have serious side effects when taking carvedilol.

Tell a doctor straight away if you have:

  • nose bleeds that last for more than 10 minutes, unexplained bruising, or you bruise more easily than usual – these can be signs of low numbers of platelets in your blood (thrombocytopenia)
  • high temperature, sore throat, mouth sores, toothache, flu-like symptoms – these can be signs of a low number of white blood cells (leukopenia)
  • shortness of breath with a cough that gets worse when you exercise (like walking up the stairs), swollen ankles or legs, chest pain, or an irregular heartbeat – these may be signs of other heart problems
  • shortness of breath, wheezing and tightening of your chest – these can be signs of lung problems
  • yellow skin or the whites of your eyes turn yellow – these can be signs of liver problems

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to carvedilol.

Immediate action required: Call 999 or go to A&E now if:
  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of carvedilol. For a full list see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects of carvedilol

What to do about:

  • feeling dizzy – as your body gets used to carvedilol this side effect should wear off. If carvedilol makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better. Do not drive or operate machinery until you feel OK again. Try to avoid alcohol as it'll make you feel worse.
  • headaches – make sure you rest and drink plenty of fluids. Ask your pharmacist to recommend a painkiller. Do not drink too much alcohol. Headaches usually go away after the first week of taking carvedilol. Talk to your doctor if the headaches last more than a week or are severe.
  • feeling tired – do not drive, ride a bike, or use tools or machinery if you’re feeling tired. Do not drink any alcohol as this will make you feel more tired.
  • feeling sick or being sick – stick to simple meals and do not eat rich or spicy food. It might help to take your carvedilol after a meal or snack. If you're being sick, try drinking small, frequent sips of water to avoid dehydration.
  • cold fingers or toes – put your hands or feet under warm running water, massage them, and wiggle your fingers and toes. Do not smoke or have drinks with caffeine, as this can make your blood vessels narrower and restrict your blood flow. It’s best not to wear tight watches or bracelets as well. Try wearing mittens (they're warmer than gloves) and warm socks. Speak to your doctor if this side effect bothers you.

7. Pregnancy and breastfeeding

Carvedilol and pregnancy

Carvedilol is not usually recommended if you’re pregnant.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about taking carvedilol. It may be possible to change to other medicines that are more suitable when you’re pregnant, such as labetalol or nifedipine.

Carvedilol and breastfeeding

If your doctor or health visitor says that your baby is healthy, it's OK to take carvedilol while breastfeeding.

There is no information about whether carvedilol passes into breast milk, but it would only be expected to pass through in small amounts. It’s unlikely to cause any side effects in your baby.

If you notice that your baby isn't feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your health visitor, midwife or doctor as soon as possible.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

There are some medicines that can affect the way carvedilol works.

Tell your doctor if you’re taking:

  • other medicines for high blood pressure – when taken together with carvedilol, they can sometimes lower your blood pressure too much
  • other medicines that can lower your blood pressure – these include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or levodopa (for Parkinson’s disease)
  • medicines for an irregular heartbeat such as amiodarone or flecainide
  • medicines for asthma or chronic obstructive pulmonary disease (COPD)
  • medicines for diabetes, particularly insulin – carvedilol may make it more difficult to recognise the warning signs of low blood sugar. Speak to your doctor if you have low blood sugar levels without getting any warning signs. You should check your blood sugar after exercise, and follow usual advice about checking it before driving, or operating machinery.
  • medicines that treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
  • medicines for allergies, such as ephedrine, noradrenaline or adrenaline
  • non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, diclofenac and naproxen – these medicines may increase your blood pressure

Mixing carvedilol with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements with carvedilol. However, some herbal products, such as cod liver oil, hawthorn and garlic tablets may cause low blood pressure (hypotension).

Important: Medicine safety

Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about carvedilol

How does carvedilol work?

Carvedilol is a type of medicine called a beta blocker.

Like other beta blockers, carvedilol works by slowing down your heart rate and making it easier for your heart to pump blood around your body.

It also works like an alpha blocker to widen some of your blood vessels. This helps lower your blood pressure.

For angina, carvedilol works by improving the blood supply to your heart. Angina is chest pain that comes on when not enough blood gets to the muscles of the heart. It usually happens because the arteries to the heart become hardened and narrowed.

Carvedilol widens the arteries so more oxygen gets to the heart and chest pain is prevented. It also slows your heart down and makes it beat more effectively. This reduces the amount of oxygen needed by your heart muscle and prevents angina.

How long does it take to work?

Carvedilol usually starts to work after about 1 hour. But it will take days or weeks to reach its full effect.

You may not feel any different when you take carvedilol for high blood pressure, but this does not mean it’s not working. It’s important to keep taking your medicine.

How long will I take it for?

Usually, treatment with carvedilol is long term. It may be for the rest of your life.

Can I take carvedilol for a long time?

Most people take carvedilol for a long time with no problems. In fact, it works best when you take it long term.

What will happen if I stop taking it?

Talk to your doctor if you want to stop taking carvedilol. If you’re bothered by side effects, your doctor may be able to prescribe a different medicine instead.

How does it compare with other medicines for high blood pressure?

Carvedilol works as well as other beta blockers to reduce blood pressure, but it’s mainly used to prevent angina or heart failure because it also widens the blood vessels.

The main difference with carvedilol is that it can affect other parts of your body too, such as your lungs.

Other medicines used to lower blood pressure work in different ways to beta blockers. These include:

The medicine your doctor prescribes first depends on your age and ethnicity. If you’re under 55 years old, you’ll usually be offered an ACE inhibitor or an angiotensin receptor blocker. If you’re 55 years old or over, or of African Caribbean or black African origin, you’ll usually be offered a calcium channel blocker.

If you are bothered by side effects, you may have to try a different blood pressure medicine. Many people need to take a combination.

How does it compare with other medicines for chest pain and angina?

There are lots of other medicines to prevent angina attacks.

They include:

  • calcium channel blockers such as diltiazem and amlodipine
  • nitrates like isosorbide mononitrate
  • medicines such as ranolazine, nicorandil or ivabradine

If carvedilol does not work for you, or you cannot take carvedilol or other beta blockers because of side effects, you may be able to switch to another medicine.

Your doctor will be able to decide which medicine is best for you. Some people may need to take a combination of medicines to control their angina symptoms.

How does it compare with other medicines that treat heart failure?

Carvedilol is used with other medicines to treat heart failure and prevent complications, These can include ACE inhibitors (like ramipril and lisinopril) or angiotensin receptor blockers (like losartan).

Other beta blockers like bisoprolol and nebivolol can be used instead of carvedilol in a similar way.

Will I need to stop carvedilol before surgery?

Tell your doctor you’re taking carvedilol if you’re going to be put to sleep (using general anaesthetic) or have any kind of major operation.

Your doctor may advise you to stop taking carvedilol before surgery.

This is because carvedilol can lower your blood pressure too much when it’s combined with some general anaesthetics.

Can I drink alcohol?

Drinking alcohol can increase the blood pressure-lowering effect of carvedilol. This can make you feel dizzy or lightheaded.

During the first few days of taking carvedilol, or after an increase in your dose, it is best to stop drinking alcohol until you see how the medicine affects you.

If you find carvedilol makes you feel dizzy it's best to stop drinking alcohol.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking carvedilol.

Eating a healthy, balanced diet can help your heart condition.

Will it affect my contraception?

Carvedilol will not stop your contraception working.

But some types of combined hormonal methods of contraception, such as the combined pill and contraceptive patch, are not usually recommended for women with high blood pressure.

Talk to your doctor if you’re taking a combined hormonal contraceptive.

If carvedilol makes you vomit, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.

Read more about what to do if you're on the pill and you're being sick.

Will it affect my fertility?

There’s no clear evidence to suggest that taking carvedilol will reduce fertility in either men or women.

If you're trying for a baby or having problems getting pregnant while on carvedilol, speak to your doctor.

Will it affect my sex life?

Some people on carvedilol say their sex drive goes down and some men say they cannot get an erection.

There’s not enough evidence to say that carvedilol causes this.

If you’re having problems with your sex life, talk to your doctor.

Do I need to avoid playing sports?

You do not need to stop playing sports if you take carvedilol. But it’s a good idea not to push yourself too much.

Regular exercise is good for you because it lowers blood pressure by keeping your heart and blood vessels in good condition.

However, in some sports carvedilol may not be allowed if you’re competing at a very high level.

Can I drive or ride a bike?

Carvedilol can make you feel tired or dizzy, especially when you first start taking it or after increasing your dose.

If this happens to you, do not drive a car, ride a bike, or use tools or machinery until you feel OK again.

Can lifestyle changes help heart problems?

If you have heart problems, you can boost the health of your heart by making some lifestyle changes.

It's a good idea to:

  • quit smoking – not smoking will bring down your blood pressure and relieve heart failure symptoms.
  • cut down on alcohol – drinking too much alcohol raises blood pressure over time and makes heart failure worse. Drinking alcohol while you're taking carvedilol can make you feel dizzy or lightheaded.
  • exercise – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Even walking every day will help.
  • eat well and lower the salt in your diet – aim to eat plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. Eating too much salt is the biggest cause of high blood pressure – the more salt you eat, the higher your blood pressure will be.
  • deal with stress – when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Finding ways to cope with stress will help to keep your blood pressure down.