Find information on thousands of medical conditions and prescription drugs.

Carvedilol

Carvedilol (Coreg®) is a non-selective beta blocker indicated in the treatment of mild to moderate congestive heart failure (CHF). In addition to blocking both β1 and β2 type adrenoreceptors, carvedilol also displays α1-adrenergic antagonism as well, which confers the added benefit of reducing blood pressure through vasodilation. more...

Home
Diseases
Medicines
A
B
C
Cabergoline
Caduet
Cafergot
Caffeine
Calan
Calciparine
Calcitonin
Calcitriol
Calcium folinate
Campath
Camptosar
Camptosar
Cancidas
Candesartan
Cannabinol
Capecitabine
Capoten
Captohexal
Captopril
Carbachol
Carbadox
Carbamazepine
Carbatrol
Carbenicillin
Carbidopa
Carbimazole
Carboplatin
Cardinorm
Cardiolite
Cardizem
Cardura
Carfentanil
Carisoprodol
Carnitine
Carvedilol
Casodex
Cataflam
Catapres
Cathine
Cathinone
Caverject
Ceclor
Cefacetrile
Cefaclor
Cefaclor
Cefadroxil
Cefazolin
Cefepime
Cefixime
Cefotan
Cefotaxime
Cefotetan
Cefpodoxime
Cefprozil
Ceftazidime
Ceftriaxone
Ceftriaxone
Cefuroxime
Cefuroxime
Cefzil
Celebrex
Celexa
Cellcept
Cephalexin
Cerebyx
Cerivastatin
Cerumenex
Cetirizine
Cetrimide
Chenodeoxycholic acid
Chloralose
Chlorambucil
Chloramphenicol
Chlordiazepoxide
Chlorhexidine
Chloropyramine
Chloroquine
Chloroxylenol
Chlorphenamine
Chlorpromazine
Chlorpropamide
Chlorprothixene
Chlortalidone
Chlortetracycline
Cholac
Cholybar
Choriogonadotropin alfa
Chorionic gonadotropin
Chymotrypsin
Cialis
Ciclopirox
Cicloral
Ciclosporin
Cidofovir
Ciglitazone
Cilastatin
Cilostazol
Cimehexal
Cimetidine
Cinchophen
Cinnarizine
Cipro
Ciprofloxacin
Cisapride
Cisplatin
Citalopram
Citicoline
Cladribine
Clamoxyquine
Clarinex
Clarithromycin
Claritin
Clavulanic acid
Clemastine
Clenbuterol
Climara
Clindamycin
Clioquinol
Clobazam
Clobetasol
Clofazimine
Clomhexal
Clomid
Clomifene
Clomipramine
Clonazepam
Clonidine
Clopidogrel
Clotrimazole
Cloxacillin
Clozapine
Clozaril
Cocarboxylase
Cogentin
Colistin
Colyte
Combivent
Commit
Compazine
Concerta
Copaxone
Cordarone
Coreg
Corgard
Corticotropin
Cortisone
Cotinine
Cotrim
Coumadin
Cozaar
Crestor
Crospovidone
Cuprimine
Cyanocobalamin
Cyclessa
Cyclizine
Cyclobenzaprine
Cyclopentolate
Cyclophosphamide
Cyclopropane
Cylert
Cyproterone
Cystagon
Cysteine
Cytarabine
Cytotec
Cytovene
Isotretinoin
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z

More importantly, carvedilol also has a minimal potential for "inverse agonism", or the deactivation of an activated receptor. This is important to CHF sufferers since inverse agonism causes negative chronotropic and inotropic effects. Essentially, carvedilol does not decrease the rate or strength of the hearts contractions as much as other beta blocking medications. CHF often significantly reduces how well the heart pumps, so any medication that further weakens the rate or strength of contractions is undesireable, therefore making carvedilol a better treatment than a beta blocker with stronger inverse agonism (such as propranolol).

On January 10, 2006, GlaxoSmithKline announced to pharmicists and physicans that there will be a limited availability of Coreg. This is due to documentation procedures with the manufacturer. It is not known when will Coreg will become broadly available. Patients who are taking Coreg should consult their healthcare professional about what actions they should take due to the shortage.

Read more at Wikipedia.org


[List your site here Free!]


Current research on carvedilol in heart failure - Letter to the Editor
From Critical Care Nurse, 8/1/02

Heart failure patients benefit from the addition of a [beta]-blocker to the standard heart failure regimen. (1) The question of which [beta]-blocker yields the greatest effect is still the subject of current research. I would like to provide additional information on [beta]-blockers that was mentioned in "Using Carvedilol to Treat Heart Failure" (April 2002:36-58). The author explained the use of carvedilol in heart failure; however, it is important to mention that there are only 3 [beta]-blockers approved by the Food and Drug Administration (FDA) for use in heart failure: carvedilol (Coreg), metoprolol succinate (Toprol-XL), and bisoprolol (Zebeta).

Like the author suggests, not all [beta]-blockers are the same. Nor is it clear that [beta]-blockers of the same generation are the same. Like carvedilol, bucindolol, a third-generation [beta]-blocker, also sought FDA approval for treatment in heart failure. The BEST trial studied the effects of bucindolol in 2708 New York Heart Association Class III (92%) and IV (8%) heart failure patients. (2) Unfortunately, the study was terminated early because there was no difference in the survival rate between the placebo group and the bucindolol group. The most interesting finding of this study was that not all [beta]-blockers are alike. Bucindolol, a nonselective [beta]-blocker that had strong [[beta].sub.2] and weak [[alpha].sub.1] blocking properties, failed to reproduce the success over placebo that has been reported using carvedilol, metoprolol, and bisoprolol in heart failure patients. (3-5)

An important factor concerning metoprolol is that there was a difference in the clinical trials between metoprolol tartrate and metoprolol succinate. The Metoprolol in Dilated Cardiomyopathy (MDC) trial (6) used metoprolol dosing 2 or 3 times a day and the Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (4) (MERIT-HF) used once a day dosing. The mean dose achieved in the MDC trial was 108 mg/day and 159 mg/day in the MERIT-HF trial. The importance of frequency and dosage was established with the MDC trial and MERIT-HF. The MDC trial could only demonstrate an improvement in the morbidity of heart failure patients. (6) The improvement in mortality was only achieved with higher dosing (150 mg) and the extended release form. (4) Carvediol is the only FDA-approved [beta]-blocker to show reduction in both mortality and morbidity from the intermediate to target doses (6.25 mg and 25 mg) within 6 months. (7) The clinical significance is tremendous because patients with heart failure begin to receive mortality benefits much earlier with carvedilol than with metoprolol succinate.

The difference in morbidity and mortality between carvedilol and metoprolol succinate in patients with heart failure was demonstrated by randomized controlled clinical trials. These findings lead to the current and ongoing question: Is selective blockade ([[beta].sub.1]) of the sympathetic nervous system more effective than nonselective ([[beta].sub.1], [[beta].sub.2], [[alpha].sub.1])? The trial that the author presented to compare the effects between carvedilol with metoprolol succinate was a brief (6 months), small (67 patients), not double-blinded study. (8) The trial was not designed to study mortality between the 2 groups. Furthermore, the extended release metoprolol was not used and the target dose of metoprolol was significantly less than previous trials (50 mg vs 150 mg). The findings of this study showed no statistical difference at 6 months between the 2 [beta]-blockers in terms of symptoms, exercise, ejection fraction, and oxidative stress.

Because heart failure is a chronic condition, a longer, larger, double-blinded study designed to investigate mortality is needed to yield the results that clinicians could apply in treating these patients. Such a study is currently underway in Europe. The Carvedilol or Metoprolol European Trial will compare the effects of metoprolol and carvedilol on all cause mortality and all cause hospitalizations and is expected to follow 3000 heart failure patients from 24 months to 44 months. (9) Until the results of this trial are published, the best answer of the question to date, in my opinion, is given in a meta-analysis by Dr Milton Packer and colleagues. (10) The meta-analysis compared all 19 randomized controlled trials with carvedilol and metoprolol, including the trials that directly compared carvedilol to metoprolol. These investigators' findings support the view that nonselective blockade of the sympathetic nervous system in addition to the antioxidant effects of carvedilol has better outcomes for patients w ith heart failure.

Rodel V. Bobadila, MSN, APRN, BC, CCRN, NP-C, FNP

References

(1.) Hunt SA, Baker DW, Chin MH, et al. ACC/ AMA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001;38:2101-2113.

(2.) Beta Blocker Evaluation of Survival Investigators. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med. 2001;344:1659-1667.

(3.) CIBIS-II Investigators and Committees. The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomized trial. Lancet. 1999;353:9-13.

(4.) Hjalmarson A, Goldstein S, Fagerberg B, et al. Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). Lancet. 1999;353:2001-2007.

(5.) Packer M, Bristow MR, Cohn JN, et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure, US Carvedilol Heart Failure study Group. N Engl J Med. 1996:334: 1349-1355.

(6.) Waagstein F, Bristow MR, Swedberg K, et al. Beneficial effects of metoprolol in idiopathic dilated Cardiomyopathy. Lancet. 1993;342:1441-1446.

(7.) Bristow MR, Gilbert EM, Abraham WT, et al. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. Circulation. 1996;94:2807-2816.

(8.) Kukin ML, Kalman J, Charney RH, et al. Prospective, randomized comparison of effect of long term treatment with metoprolol or carvedilol on symptoms, exercise, ejection fraction and oxidative stress in heart failure. Circulation. 1999;99:2645-2651.

(9.) Poole-Wilson P, Camerini F, Cleland J, et al. Carvedilol or metoprolol (poster].

(10.) Packer M, Antonopoulos GV, Berlin JA, et al. Comparative effects of carvedilol and metoprolol on left ventricular ejection fraction in heart failure: results of a meta-analysis. Am Heart J. 2001;141:899-907.

COPYRIGHT 2002 American Association of Critical-Care Nurses
COPYRIGHT 2003 Gale Group

Return to Carvedilol
Home Contact Resources Exchange Links ebay