Starting dosage

3.125 mg taken twice daily for two weeks. This dosage is the same regardless of the age or weight of the patient. Carvedilol should be taken with food. Patient should be observed in the office for one hour after initial dose is given.

Titration

If previous dosage was well-tolerated, dosage should be doubled every two weeks to the maximum dosage or the highest tolerated dosage. Patient should be observed in the office for one hour after every dosage adjustment.

Maximum dosage

Patients weighing < 85 kg (187 lb): 25 mg twice daily

Patients weighing > 85 kg (187 lb): 50 mg twice daily

Monitoring

Patient should be weighed daily. Any weight gain of 0.91 to 1.36 kg (2 to 3 lb) should be reported to the physician. Blood pressure measurements should be taken with the patient standing. Parameters of glycemic and lipid control should be monitored, and medicines should be adjusted appropriately.

Indication

Clinically stable NYHA functional class II or class III heart failure. Therapy with ACE inhibitors should be initiated and stabilized before the introduction of carvedilol therapy. Patients should not be in the hospital for heart failure or in a fluid-overload state.

Contraindications

Bronchial asthma or related bronchospastic conditions; decompensated NYHA functional class IV heart failure requiring intravenous inotropic therapy; should not be used in patients with severe hepatic impairment, severe bradycardia, second-or third-degree arteriovenous block or sick sinus syndrome without a pacemaker, or in patients with a known hypersensitivity to carvedilol.

Precautions

May affect lipid and blood sugar levels. May mask signs or symptoms of hypoglycemia and hyperthyroidism. Should be used with caution in patients with peripheral vascular disease.