What is Coreg (carvedilol)?

Coreg is Carvedilol: A Comprehensive Beta-Blocker for Heart Failure and Hypertension

Coreg is carvedilol, a non-selective beta-blocker with additional alpha-1 blocking properties that is FDA-approved for treating heart failure, hypertension, and left ventricular dysfunction after myocardial infarction. 1

Pharmacology and Mechanism of Action

Carvedilol has a unique pharmacological profile that distinguishes it from other beta-blockers:

• Multiple receptor blockade: Blocks beta-1, beta-2, and alpha-1 adrenergic receptors 1, 2
• Vasodilatory effects: The alpha-1 blockade produces vasodilation, reducing peripheral resistance 2
• Antioxidant properties: Carvedilol and its metabolites have potent antioxidant effects that may contribute to cardioprotection 2

Clinical Applications

Carvedilol is FDA-approved for:

1. Heart Failure with Reduced Ejection Fraction (HFrEF)

   • Reduces mortality by approximately 34-65% in heart failure patients 3
   • Decreases hospitalizations for heart failure by 31% 3
   • Improves left ventricular function and reverses cardiac remodeling 3

2. Hypertension

   • Reduces blood pressure through combined beta-blockade and alpha-1-mediated vasodilation 2
   • Maintains cardiac output due to reduced afterload offsetting negative inotropic effects 2

3. Left Ventricular Dysfunction After Myocardial Infarction

   • Provides cardioprotection in post-MI patients 1

Dosing and Administration

• Starting dose: 3.125 mg twice daily for heart failure 4
• Target dose: 25-50 mg twice daily (based on patient weight and tolerance) 4
• Administration: Take with food to improve absorption and reduce orthostatic effects 1
• Titration: Double the dose every 2 weeks if tolerated, monitoring for bradycardia, hypotension, and worsening heart failure symptoms 4

Comparison to Other Beta-Blockers

Only three beta-blockers have demonstrated mortality benefit in heart failure:

1. Carvedilol: Non-selective beta-blocker with alpha-1 blocking properties
2. Metoprolol succinate: Beta-1 selective blocker (extended-release formulation)
3. Bisoprolol: Highly beta-1 selective blocker

The COMET trial demonstrated a 17% greater mortality reduction with carvedilol compared to metoprolol tartrate 3, suggesting potential superiority of carvedilol. The American College of Cardiology often recommends carvedilol as preferred due to its additional alpha-blocking properties 4.

Adverse Effects and Precautions

Common side effects include:

• Dizziness or lightheadedness (due to alpha-blockade)
• Fatigue
• Hypotension
• Bradycardia
• Worsening heart failure symptoms during initiation

Contraindications:

• Severe bradycardia
• Second or third-degree heart block without pacemaker
• Cardiogenic shock
• Decompensated heart failure requiring IV inotropic therapy
• Severe asthma 1

Special Considerations

• COPD/Asthma: Cardioselective beta-blockers (metoprolol, bisoprolol) may be preferred over carvedilol in patients with reactive airway disease 4
• Diabetes: Carvedilol has more favorable effects on glycemic control compared to some other beta-blockers 3
• Elderly: Start with lower doses and titrate more gradually, monitoring for orthostatic hypotension 4
• Women: May experience higher exposure to beta-blockers like carvedilol due to pharmacokinetic differences, potentially requiring lower doses 3

Clinical Pearls

• Never abruptly discontinue carvedilol as this may precipitate angina, myocardial infarction, or arrhythmias 1
• Take with food to minimize side effects 1
• Start low and go slow with dose titration, especially in elderly patients or those with significant comorbidities 4
• Monitor heart rate, blood pressure, and symptoms of worsening heart failure during titration 4

Carvedilol (Coreg) represents an important advancement in beta-blocker therapy with its unique pharmacological profile and proven mortality benefits in heart failure and post-MI patients.