Coreg (Carvedilol) Oral: Uses, Side Effects, Dosages
What Is Coreg?
Coreg (carvedilol) is a beta-blocker with alpha-1 blocking activity used to treat heart failure and high blood pressure. It works by blocking the action of both alpha receptors and beta receptors to reduce the heart’s workload and help it beat more regularly.
Coreg is available by prescription as an oral tablet and extended-release (ER) capsule (Coreg CR).
Drug Facts
Generic Name: Carvedilol
Brand Name(s): Coreg, Coreg CR
Drug Availability: Prescription
Administration Route: Oral
Therapeutic Classification: Cardiovascular agent
Available Generically: Yes
Controlled Substance: N/A
Active Ingredient: Carvedilol
Dosage Form(s): Tablet, extended-release capsule
What Is Coreg Used For?
The Food and Drug Administration (FDA) approved Coreg to treat adults with:
Coreg is not approved for children under age 18 but is frequently used off-label.
How to Take Coreg
Take Coreg as prescribed by your healthcare provider. How much you take and how long you need to take it will likely be based on your condition.
Take the pills with food to slow their absorption into the bloodstream and reduce the risk of low blood pressure (hypotension) side effects, also known as orthostatic hypotension.
Do not crush, chew, or split the extended-release capsules. However, you may open the capsules to sprinkle the contents onto applesauce for immediate use.
Storage
Store carvedilol tablets at room temperature between 68 and 72 degrees Fahrenheit. Keep them protected from light and extreme heat.
Off-Label Uses
Healthcare providers may prescribe Coreg for off-label uses, meaning for conditions not specifically indicated by the FDA.
Coreg is sometimes used off-label:
- As part of medical management following a heart attack
- To control heart rate in people with atrial fibrillation (irregular heart rate)
- To reduce angina pectoris (chest pain)
- To reduce a type of high blood pressure (portal hypertension) in people with cirrhosis (extensive scarring of the liver)
- To prevent variceal bleeding in people with cirrhosis and esophageal varices (abnormal veins)
How Long Does Coreg Take to Work?
Coreg reaches peak plasma concentration within one to two hours after taking it, but it can take days or weeks for the full benefits to take effect.
What Are the Side Effects of Coreg?
This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.
Common Side Effects
Common side effects of Coreg include:
Severe Side Effects
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Serious side effects and their symptoms can include the following:
- Atrioventricular (AV) block (heart block): Symptoms include dizziness, fainting, tiredness, shortness of breath
- Worsening heart failure or fluid retention
- Allergic skin reactions
- Sudden severe worsening of asthma
Long-Term Side Effects
Stopping this medication abruptly can heighten the risk of rebound or withdrawal hypertension or angina. Your healthcare provider should taper (gradually reduce your daily dose) your Coreg treatment over the course of at least one week to lessen this side effect.
Report Side Effects
Coreg may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your healthcare provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Dosage: How Much Coreg Should I Take?
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The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
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For oral dosage form (extended-release capsules):
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For heart failure:
- Adults—At first, 10 milligrams (mg) once a day for at least two weeks. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day.
- Children—Use and dose must be determined by your doctor.
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For hypertension:
- Adults—At first, 20 milligrams (mg) once a day for 7 to 14 days. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day.
- Children—Use and dose must be determined by your doctor.
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For left ventricular dysfunction after a heart attack:
- Adults—At first, 20 milligrams (mg) once a day for 3 to 10 days. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day
- Children—Use and dose must be determined by your doctor.
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For heart failure:
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For oral dosage form (tablets):
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For congestive heart failure:
- Adults—At first, 3.125 milligrams (mg) two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 25 or 50 mg two times a day.
- Children—Use and dose must be determined by your doctor.
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For high blood pressure (hypertension):
- Adults—At first, 6.25 milligrams (mg) two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 25 mg two times a day.
- Children—Use and dose must be determined by your doctor.
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For left ventricular dysfunction after a heart attack:
- Adults—At first, 6.25 milligrams (mg) two times a day. Some patients may start at 3.125 mg two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 25 mg two times a day.
- Children—Use and dose must be determined by your doctor.
-
For congestive heart failure:
Modifications
Your healthcare provider may consider certain factors when prescribing you Coreg, including:
- Your age
- Pregnancy or breastfeeding status
- Side effects
In some cases, you may need a dosage adjustment of your medication, or you may need to stop taking Coreg altogether.
Pregnancy
Coreg is generally not used during pregnancy. There are other blood pressure medications with more safety data that may be better options. Tell your healthcare provider if you become pregnant or plan to become pregnant while on Coreg, as you may need to switch to another therapy.
Breastfeeding
It is not known whether Coreg is passed in human breast milk . There is no published data on Coreg’s effects on breastfed infants, so other medications are generally preferred.
Age
The safety and efficacy of Coreg in children have not been established, though it has been used off-label to treat children with heart failure and a heart muscle disease called dilated cardiomyopathy.
Side Effects
Although there is no difference in safety when using Coreg in adults 65 and older, studies have shown that people in this age group experienced dizziness more frequently than those under 65. If this is the case for you, your healthcare provider may reduce the dose of your medication.
Missed Dose
If you miss a dose of Coreg, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and take the next dose at the regularly scheduled time. Do not take an extra dose to make up for the missed dose.
Overdose: What Happens If I Take Too Much Coreg?
Overdosage with Coreg may cause the following:
- Severe hypotension (low blood pressure)
- Bradycardia (low heart rate)
- Cardiogenic shock
- Cardiac arrest
Treatment is supportive with intravenous fluids and medications that support heart function. Activated charcoal may be helpful if given shortly after ingestion.
Adults who unintentionally ingest 50 milligrams (mg) or less of Coreg may be monitored at home as long as they do not have any symptoms discussed above. If you ingest more than 50 milligrams or in the event of intentional ingestion, or if any symptoms of overdose are present, you should be observed by a healthcare provider in a medical facility for six to eight hours.
What Happens If I Overdose on Coreg?
Overdose symptoms may include dizziness, lapses of consciousness, vomiting, bronchospasms, respiratory problems, and seizures.
If you think you or someone else may have overdosed on Coreg, call your healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn’t breathing after taking Coreg, call 911.
Precautions
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It is important that your doctor check your progress at regular visits to make sure this medicine is working properly and to allow for changes in the dose.
This medicine may cause dizziness, lightheadedness, or fainting. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.
Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position suddenly. These symptoms are more likely to occur when you begin taking this medicine, or when the dose is increased. Sitting or lying down may help alleviate these unwanted effects.
Before having any kind of surgery (including dental surgery or cataract surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine. A serious eye problem called Intraoperative Floppy Iris Syndrome (IFIS) has occurred in some patients who were taking this medicine or who had recently taken this medicine when they had cataract surgery.
For diabetic patients:
- This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of hypoglycemia (low blood sugar), such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.
For congestive heart failure patients:
- Check with your doctor if you have unexplained weight gain or increased shortness of breath. These may be signs of a worsening of your condition.
For patients who wear contact lenses:
- Carvedilol may cause your eyes to form tears less than they do normally. Check with your doctor if you have dry eyes.
Do not interrupt or stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are Reasons I Shouldn’t Take Coreg?
Your healthcare provider may decide not to prescribe Coreg for you if you have:
- A known hypersensitivity (allergy) to carvedilol or any of its inactive ingredients
- Bronchial asthma or related bronchospastic conditions. Deaths from severe acute asthma have been reported after single doses of Coreg.
- Decompensated heart failure requiring intravenous inotropic medications
- Severe liver problems
Unless you have a functioning pacemaker, do not take Coreg if you have heart conditions, including:
What Other Medications Interact With Coreg?
Coreg may interact with other medications, including:
- Digoxin
- Pacerone (amiodarone)
- Diltiazem or verapamil
- Hypotensive agents (drugs that lower blood pressure)
- Insulin or oral hypoglycemics
- Cyclosporine
- Inducers/inhibitors of liver metabolism
Digoxin
Both digoxin and carvedilol slow electrical conduction in the heart and decrease heart rate. Digoxin concentrations in the body increase when taken with Coreg. Therefore, increased monitoring of digoxin levels should occur when starting, adjusting, or stopping carvedilol.
Amiodarone
Amiodarone increases levels of carvedilol in the blood. Taking amiodarone with Coreg may further slow the heart rate or cardiac electrical conduction. People taking this combination should watch for low heart rate, dizziness, tiredness, and shortness of breath.
Diltiazem or Verapamil
The calcium channel blockers diltiazem and verapamil can cause electrical conduction disturbances in the heart when taken with Coreg. Your healthcare provider may monitor your blood pressure and electrocardiogram if you take these medications with Coreg.
Hypotensive Agents
Use caution if taking Coreg with a medication that can deplete catecholamines (e.g., reserpine and monoamine oxidase inhibitors). Catecholamines are monoamine neurotransmitters released in the blood in response to physical or emotional stress. Monitor for low blood pressure and severe low heart rate.
The use of clonidine (e.g., Catapres) and Coreg together can increase the risk of low blood pressure and low heart rate. If stopping both medications, Coreg should be stopped first, followed by clonidine several days later by gradually reducing the dose.
Insulin or Oral Hypoglycemics
Coreg may increase the blood sugar-lowering effects of insulin and oral diabetes medications. If used together, monitor blood sugars regularly.
Cyclosporine
Adding Coreg to cyclosporine (e.g., Sandimmune, Neoral, Gengraf) may cause an increase in cyclosporine blood concentrations. Your healthcare provider may closely monitor blood levels to determine if a cyclosporine dosage reduction is needed.
Inducers/Inhibitors of Liver Metabolism
Carvedilol is extensively metabolized by the liver. Medications that inhibit liver metabolism (e.g., amiodarone, bupropion, duloxetine, and cimetidine) may increase blood levels of Coreg and cause enhanced blood pressure-lowering and heart rate-lowering effects. Medications that increase liver metabolism (e.g., rifampin) will reduce blood levels of Coreg and may require an increase in dose.
Tell your healthcare provider about any medications, supplements, and herbs you are taking or will start taking when you begin treatment with Coreg.
What Medications Are Similar?
Trandate (labetalol) is another beta-blocker with alpha-blocking activity. Beta-blockers that do not have alpha-blocking activity (e.g., metoprolol, atenolol, propranolol) are also closely related.
These medications differ in their affinity for different beta receptors in the heart and whether they also have activity on alpha receptors. In most cases, people should only take one oral beta-blocker at a time.
Coreg’s unique place in therapy is its role in reducing disease progression and deaths in people with heart failure. Other beta-blockers used to reduce death in heart failure with left ventricular dysfunction include metoprolol succinate (metoprolol CR/XL), also known by the brand names Lopressor and Toprol XL, and bisoprolol, known by brand names Monocor and Zebeta.
How Can I Stay Healthy While Taking Coreg?
Coreg is proven to help people with heart failure, so you should feel assured if you are taking it for this reason. In order to receive the maximal benefit, take the medication daily without missing doses.
If you experience any of the common side effects (e.g., dizziness, feeling tired, low blood pressure symptoms), it is important to work closely with your healthcare provider to adjust the dose of Coreg or your other medications. Often, a dose reduction can help. So don’t worry if you start feeling side effects after taking your medication.
You may want to keep a current list of all the medications you take so that you can share the information with other members of your healthcare team if needed. Try to also stay adherent to your medication schedule, taking your doses on time. Using a pill tracking calendar, a medication app on your smartphone, or a pill organizer, can help keep you on track.
Medical Disclaimer
Verywell Health’s drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
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