From the Guidelines
For coreg (carvedilol), you should hold the medication if the patient's heart rate is less than 50 beats per minute or if systolic blood pressure is less than 90 mmHg. These parameters are important because carvedilol is a beta-blocker that slows heart rate and lowers blood pressure, as indicated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Administering the medication when these vital signs are already low could lead to dangerous bradycardia or hypotension. If you need to hold a dose, document the reason and notify the prescriber. When the patient's heart rate and blood pressure return to safe levels (heart rate ≥50 bpm and systolic BP ≥90 mmHg), the medication can typically be resumed. For patients with heart failure, these parameters may be adjusted by the prescriber based on individual clinical status, as some patients may tolerate lower parameters under careful monitoring, as noted in the guideline 1. Always assess for symptoms of dizziness, lightheadedness, or syncope before administration, even if vital signs are within range. It's also important to consider the usual dose range of carvedilol, which is 12.5-50 mg/day, and the daily frequency, which is typically 2 times a day, as specified in the guideline 1. Additionally, avoid abrupt cessation of carvedilol, as it may cause rebound hypertension, and instead taper the medication if necessary, as recommended in the guideline 1.
Some key points to consider when holding coreg (carvedilol) include:
- Heart rate less than 50 beats per minute
- Systolic blood pressure less than 90 mmHg
- Documenting the reason for holding the dose and notifying the prescriber
- Assessing for symptoms of dizziness, lightheadedness, or syncope before administration
- Considering the individual clinical status of patients with heart failure when adjusting parameters
- Avoiding abrupt cessation of carvedilol and instead tapering the medication if necessary.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Coreg Parameters
- The parameters for Coreg (carvedilol) can be understood by examining its pharmacological properties and therapeutic use in cardiovascular disorders 2.
- Carvedilol competitively blocks beta 1, beta 2, and alpha 1 receptors, and has vasodilating properties that are exerted primarily through alpha 1-blockade 2.
- The drug has been shown to improve exercise tolerance and ischaemic symptoms in patients with stable angina pectoris, and to reduce serious cardiac events after acute myocardial infarction and the frequency and severity of ischaemic events in patients with unstable angina 2.
Combination Therapy
- The combination of carvedilol and ivabradine has been shown to improve left ventricular diastolic dysfunction, clinical progression, and survival in cirrhosis 3.
- In patients with systolic heart failure, the combination of carvedilol and ivabradine has been shown to reduce the risk of cardiovascular death or heart failure hospitalization 4.
- The dosage of carvedilol has been found to have no detectable effect on the outcome of combination therapy with ivabradine 4.
Bradycardia Risk
- The risk of emergent bradycardia associated with the use of carvedilol and metoprolol has been compared in routine clinical practice, with results showing that initiation of metoprolol is associated with an increased risk of emergent bradycardia compared with carvedilol 5.
- However, the overall incidence of emergent bradycardia is low in routine clinical practice, with an incidence of 18.1 per 1000 person-years using metoprolol and 17.7 per 100 person-years using carvedilol 5.
- The evaluation and management of bradycardia requires consideration of symptoms and underlying pathology, rather than relying solely on heart rate cutoffs or pause duration 6.