From the Guidelines
Coreg (carvedilol) can be used in patients with asthma, but with caution and close medical supervision. As a non-selective beta-blocker, carvedilol may pose risks due to its beta-2 blockade, which can cause bronchoconstriction and potentially trigger or worsen asthma symptoms 1. However, the contraindication to beta-blockers in asthma is based on outdated studies with high initial dosages in young patients with severe asthma, and recent guidelines suggest that asthma is not an absolute contraindication to beta-blocker use 1.
Key considerations for using Coreg in patients with asthma include:
- Starting with low doses and combining with close monitoring for signs of airway obstruction, such as wheezing and shortness of breath 1
- Preferably using cardioselective beta-blockers like bisoprolol, metoprolol succinate, or nebivolol, which have less effect on the airways 1
- Evaluating the risk-benefit ratio on an individual basis, considering the severity of both cardiac and respiratory conditions 1
- Ensuring patients are under close medical supervision by a specialist and are educated to report any worsening of breathing immediately 1.
Overall, while Coreg can be used in patients with asthma, it requires careful consideration and monitoring to minimize potential risks and ensure the best possible outcomes for patients with both heart failure and asthma.
From the FDA Drug Label
Carvedilol Tablet is contraindicated in the following conditions: Bronchial asthma or related bronchospastic conditions. Do not take Carvedilol Tablet if you: Are prone to asthma or other breathing problems Have asthma or other lung problems (such as bronchitis or emphysema)
Coreg (carvedilol) is not safe to use in patients with asthma. The drug label explicitly states that carvedilol is contraindicated in patients with bronchial asthma or related bronchospastic conditions, and patients prone to asthma or other breathing problems should not take the medication 2, 2.
From the Research
Coreg and Asthma
- Coreg, also known as carvedilol, is a non-selective beta-blocker with alpha-1 blocking activity, which can be a concern for patients with asthma 3, 4, 5.
- Non-selective beta-blockers, like Coreg, can worsen asthma symptoms or trigger bronchospasm, especially in patients with severe asthma 3, 5.
- However, cardioselective beta-blockers, which are less likely to affect the beta-2 receptors in the lungs, may be safer for patients with asthma 4, 6.
Safety of Coreg in Asthma Patients
- There is limited evidence on the safety of Coreg specifically in patients with asthma, but studies suggest that cardioselective beta-blockers may be a safer option 6.
- One study found that cardioselective beta-blockers were not associated with an increased risk of asthma exacerbations 6.
- Another study reported a case of betaxolol-induced deterioration of asthma, but this was with a different beta-blocker 7.
Precautions and Alternatives
- Patients with asthma should use Coreg with caution and under close medical supervision 3, 4, 5.
- Alternative therapies, such as calcium antagonists, ACE inhibitors, or diuretics, may be considered for patients with hypertension or heart failure who also have asthma 5.
- If Coreg is prescribed, patients should be monitored closely for signs of asthma worsening or bronchospasm, and bronchodilators should be readily available 4.