Maximum Dose of Carvedilol (Coreg)
The maximum dose of carvedilol is 50 mg total daily, administered as 25 mg twice daily. 1
Dosing by Indication
Heart Failure with Reduced Ejection Fraction (HFrEF)
- Target dose: 25 mg twice daily (50 mg total daily) for patients weighing over 85 kg 2
- Starting dose: 3.125 mg twice daily, with dose doubling every 1-2 weeks if tolerated 2
- Titration schedule: 3.125 mg → 6.25 mg → 12.5 mg → 25 mg twice daily 2
- The FDA label confirms that total daily dose should not exceed 50 mg 1
Post-Myocardial Infarction with Left Ventricular Dysfunction
- Target dose: 25 mg twice daily 1
- Starting dose: 6.25 mg twice daily (or 3.125 mg twice daily if clinically indicated due to low blood pressure, heart rate, or fluid retention) 1
- Increase after 3 to 10 days to 12.5 mg twice daily, then to target dose of 25 mg twice daily based on tolerability 1
Hypertension
- Maximum dose: 25 mg twice daily (50 mg total daily) 1
- Starting dose: 6.25 mg twice daily 1
- Titration: Maintain for 7-14 days, then increase to 12.5 mg twice daily if needed, then to 25 mg twice daily if tolerated 1
- The FDA label explicitly states that total daily dose should not exceed 50 mg 1
Clinical Context from Guidelines
The ACC/AHA guidelines list carvedilol dosing for angina as "6.25 mg twice daily, uptitrated to a maximum of 25 mg twice daily" 3, which aligns with the FDA-approved maximum of 50 mg total daily dose 1.
Important Caveats
- Never exceed 50 mg total daily dose regardless of indication 1
- Patients should be maintained on lower doses if higher doses are not tolerated 1
- Carvedilol must be taken with food to slow absorption and reduce orthostatic effects 1
- Abrupt discontinuation should be avoided as it can precipitate rebound hypertension or worsening heart failure 2
- The controlled-release formulation (Coreg CR) has a maximum dose of 80 mg once daily, which is distinct from immediate-release carvedilol 4, 2