Can patients with asthma take Carvedilol (coreg)?

From the Guidelines

Asthmatics should generally avoid carvedilol due to its potential to worsen asthma symptoms, but if necessary, it can be used under close medical supervision with careful consideration of the risks and benefits, as stated in the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1.

Key Considerations

• Carvedilol is a non-selective beta-blocker that blocks both beta-1 receptors (affecting the heart) and beta-2 receptors (affecting the lungs), which can cause bronchoconstriction and potentially trigger asthma attacks.
• The contraindication to beta-blockers in asthma is based on small case series published in the 1980s and late 1990s with very high initial dosages in young patients with severe asthma, but starting with low doses of cardioselective beta-blockers combined with close monitoring for signs of airway obstruction may allow their use in certain cases 1.
• Cardioselective beta-blockers such as metoprolol or bisoprolol are usually safer alternatives for patients with asthma who require treatment for conditions like heart failure or high blood pressure, as they primarily target beta-1 receptors in the heart with less effect on the lungs.

Recommendations

• Any asthmatic currently taking carvedilol or considering it should discuss their complete medical history with their healthcare provider to determine the most appropriate treatment option.
• In emergency situations, having rescue inhalers readily available is essential if an asthmatic must take carvedilol.
• The use of beta-blockers, including carvedilol, should be individualized and based on the specific clinical context, taking into account the potential benefits and risks, as well as the availability of alternative treatments. Some key points to consider when making this decision include:
• The severity of the patient's asthma and their response to previous treatments
• The presence of any other medical conditions that may be affected by the use of beta-blockers
• The potential benefits of using carvedilol, such as improved heart failure outcomes, and the potential risks, such as worsening asthma symptoms. According to the 2016 ESC guidelines, beta-blockers are only relatively contraindicated in asthma, and a more selective β1-adrenoceptor antagonist is preferred 1.

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)

Asthmatics should not take carvedilol. 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

Asthmatics and Carvedilol

• The safety of carvedilol in asthmatics is a topic of interest, with some studies suggesting it may be tolerated in certain individuals 3, 4, 5.
• A study published in 2021 found that cardioselective beta-blockers, such as carvedilol, may not be associated with an increased risk of asthma exacerbations 3.
• Another study from 2017 reported that cardioselective beta-blocker use was not associated with a significantly increased risk of moderate or severe asthma exacerbations 4.
• However, a 2002 study found that patients with heart failure and concomitant asthma tolerated carvedilol poorly, with only 50% of patients able to tolerate the medication 5.
• In contrast, patients with heart failure and concomitant chronic obstructive pulmonary disease (COPD) tolerated carvedilol well, with no significant reversible airflow limitation 5.
• A 2024 study investigated the prescription of beta-blockers, including carvedilol, in patients with asthma, and found that carvedilol was one of the most commonly prescribed non-selective beta-blockers in this population 6.
• The study also found that co-prescribing of bronchodilators occurred at a rate of 38.7% and 45.1% for non-selective and selective beta-blocker prescriptions, respectively 6.
• A 2021 study found that the bronchodilator response to salbutamol was not impaired during treatment with the cardio-selective beta1-blocker bisoprolol, but did not specifically investigate carvedilol 7.