From the Guidelines
Coreg, or carvedilol, is a recommended beta-blocker for all patients with current or prior symptoms of heart failure with reduced ejection fraction (HFrEF), unless contraindicated, to reduce morbidity and mortality. The use of carvedilol has been shown to lessen the symptoms of heart failure, improve clinical status, and enhance overall sense of well-being 1. Long-term treatment with beta blockers, such as carvedilol, can reduce the risk of death and the combined risk of death or hospitalization, with benefits seen in patients with or without coronary artery disease and in patients with or without diabetes mellitus 1.
Key Points
- The typical starting dose for hypertension is 6.25 mg twice daily, which can be gradually increased to 25 mg twice daily if needed.
- For heart failure, treatment usually begins at 3.125 mg twice daily for two weeks, with gradual increases to a target dose of 25 mg twice daily for patients under 85 kg, or 50 mg twice daily for those over 85 kg.
- Carvedilol works by blocking certain receptors in the heart and blood vessels, reducing heart rate and blood pressure while improving heart function.
- It's different from many other beta-blockers because it also blocks alpha-1 receptors, providing additional blood vessel dilation.
- Common side effects include dizziness, fatigue, and low blood pressure.
- Patients should take Coreg with food to minimize dizziness and should not abruptly stop taking it without medical supervision, as this can worsen underlying heart conditions.
Evidence-Based Recommendation
The 2013 ACCF/AHA guideline for the management of heart failure recommends the use of one of the three beta blockers proven to reduce mortality, including carvedilol, for all patients with current or prior symptoms of HFrEF, unless contraindicated 1. Additionally, the CarvedilOl ProspEctive RaNdomIzed CU-mulative Survival (COPERNICUS) trial demonstrated that carvedilol reduced the mortality risk at 12 months by 38% and the risk of death or hospitalization for heart failure by 31% 1. Therefore, carvedilol is a recommended treatment option for patients with heart failure, due to its proven benefits in reducing morbidity and mortality.
From the FDA Drug Label
Carvedilol Tablet is indicated to reduce cardiovascular mortality in clinically stable patients who have survived the acute phase of a myocardial infarction and have a left ventricular ejection fraction of less than or equal to 40% (with or without symptomatic heart failure) Carvedilol Tablet is indicated for the management of essential hypertension
- Indications for Coreg (Carvedilol):
- Reduce cardiovascular mortality in patients with left ventricular dysfunction after myocardial infarction
- Management of essential hypertension
- Key Points:
- Can be used alone or in combination with other antihypertensive agents
- Should be used with caution in certain patient populations, such as those with bronchospastic disease or peripheral vascular disease 2
From the Research
Coreg (Carvedilol) Overview
- Coreg, also known as carvedilol, is a beta-blocker used in the treatment of chronic heart failure and high blood pressure.
- The effectiveness of Coreg in comparison to other beta-blockers has been studied in various research papers 3, 4, 5, 6.
Comparison with Other Beta-Blockers
- A study published in 2017 compared bisoprolol, carvedilol, and metoprolol succinate in the treatment of patients with chronic heart failure, and found that bisoprolol and carvedilol were associated with lower mortality compared to metoprolol succinate 4.
- Another study published in 2015 compared carvedilol with metoprolol succinate and found no conclusive association between all-cause mortality and treatment with either drug 5.
- A 2023 study evaluated the effectiveness and safety of four different beta-blockers, including bisoprolol, metoprolol, carvedilol, and nebivolol, and found that bisoprolol improved the prognosis of chronic heart failure in comparison with carvedilol 6.
Key Findings
- The choice of beta-blocker is important, as benefit is not a class-effect 3.
- Bisoprolol, metoprolol succinate, and carvedilol are considered to have optimal efficacy in the treatment of chronic heart failure 3, 4, 6.
- Adverse reactions associated with beta-blockers are mainly related to beta-2 blockade and alpha-blockade 3.