From the Guidelines
The recommended starting dose of carvedilol for hypertension is 12.5 mg taken orally twice daily, which can be gradually increased to a maximum of 50 mg twice daily, based on patient response and tolerability, as per the most recent guidelines 1. This dose is based on the latest evidence from 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.
- Carvedilol is a non-selective beta-blocker with additional alpha-1 blocking properties, which contributes to its blood pressure lowering effect.
- It works by reducing cardiac output and peripheral vascular resistance.
- Patients with severe hepatic impairment may require lower doses.
- It's essential to note that abrupt discontinuation should be avoided due to the risk of rebound hypertension.
- When initiating therapy, monitor blood pressure and heart rate regularly, and adjust the dose accordingly to achieve the desired therapeutic effect. The previous guideline from 2013 also supported the use of carvedilol for hypertension, but with a starting dose of 6.25 mg twice daily, uptitrated to a maximum of 25 mg twice daily 1. However, the most recent guideline from 2018 takes precedence, and its recommendations should be followed in clinical practice.
From the FDA Drug Label
DOSAGE MUST BE INDIVIDUALIZED. The recommended starting dose of Carvedilol Tablet is 6.25 mg twice daily. If this dose is tolerated, using standing systolic pressure measured about 1 hour after dosing as a guide, the dose should be maintained for 7 to 14 days, and then increased to 12. 5 mg twice daily if needed, based on trough blood pressure, again using standing systolic pressure one hour after dosing as a guide for tolerance. This dose should also be maintained for 7 to 14 days and can then be adjusted upward to 25 mg twice daily if tolerated and needed. The full antihypertensive effect of Carvedilol Tablets is seen within 7 to 14 days Total daily dose should not exceed 50 mg.
The dose of carvedilol for hypertension (HTN) is:
- Starting dose: 6.25 mg twice daily
- Target dose: up to 25 mg twice daily
- Maximum daily dose: not to exceed 50 mg 2
From the Research
Dose of Carvedilol for Hypertension
The dose of carvedilol for hypertension (HTN) can vary based on the formulation and the patient's response to the medication.
- The controlled-release (CR) formulation of carvedilol allows for once-daily dosing, with doses ranging from 20 mg to 80 mg once daily 3.
- The immediate-release (IR) formulation of carvedilol is taken twice daily, with doses ranging from 6.25 mg to 25 mg twice daily 3.
- A dose-response study found that doses of 12.5 mg and 25 mg carvedilol once a day are adequate for the treatment of hypertension 4.
- Another study compared carvedilol with atenolol in the treatment of mild-to-moderate essential hypertension, with carvedilol doses ranging from 25 mg to 50 mg once daily 5.
- A dose-response study found that carvedilol 12.5,25, and 50 mg administered once daily for 4 weeks effectively reduced blood pressure for 24 hours 6.
Formulation and Dosing
The choice of formulation and dosing schedule may depend on the individual patient's needs and response to the medication.
- The CR formulation may be preferable to the IR formulation due to its once-daily dosing schedule and reduced adverse events 3, 7.
- The dose of carvedilol can be titrated based on the patient's response to the medication, with higher doses used for patients who do not respond adequately to lower doses 3, 5.