Carvedilol 20mg Equivalent Dosing
Carvedilol 20mg twice daily (40mg total daily) is approximately equivalent to metoprolol succinate 100-120mg once daily or bisoprolol 5mg once daily based on beta-blocking potency and clinical trial dosing.
Beta-Blocker Dose Equivalency Framework
The equivalent dosing between beta-blockers is based on the target doses achieved in major heart failure trials and their relative beta-blocking potency:
Carvedilol to Metoprolol Conversion
- Carvedilol 20mg twice daily (40mg total) ≈ Metoprolol succinate 100-120mg once daily 1
- The target dose of carvedilol in clinical trials was 25-50mg twice daily (mean achieved 37mg total daily), while metoprolol succinate target was 200mg once daily (mean achieved 159mg total daily) 1
- This suggests an approximate 4:1 ratio (metoprolol:carvedilol) for equivalent beta-blockade 1
Carvedilol to Bisoprolol Conversion
- Carvedilol 20mg twice daily ≈ Bisoprolol 5mg once daily 1
- Bisoprolol target dose was 10mg once daily (mean achieved 8.6mg daily) in clinical trials 1
- The approximate ratio is 4:1 (carvedilol:bisoprolol) 1
Important Clinical Context
Carvedilol's Unique Properties
Carvedilol differs from other beta-blockers because it provides both beta-blockade and alpha-1 receptor blockade, producing vasodilation 2. This dual mechanism means direct dose equivalency is imperfect—carvedilol may provide additional blood pressure lowering beyond pure beta-blockade 2.
Evidence-Based Target Dosing
The FDA label specifies that in the CAPRICORN trial (post-MI patients with LV dysfunction), the mean carvedilol dose achieved was 20mg twice daily 3. For heart failure, patients were titrated from 6.25mg twice daily to a target of 25mg twice daily 3.
Titration Considerations
- Starting dose: Carvedilol 3.125mg twice daily 1
- Target dose: 25-50mg twice daily (depending on body weight <75kg vs >75kg) 1
- Titration interval: Every 2-4 weeks, doubling the dose if tolerated 1
Common Pitfalls to Avoid
Do not assume 1:1 equivalency between beta-blockers—the pharmacologic profiles differ substantially, and carvedilol's alpha-blocking effects provide additional hemodynamic benefits not captured by simple beta-blocking potency 2.
Avoid switching formulations without understanding trial evidence—only metoprolol succinate (extended-release), not metoprolol tartrate, demonstrated mortality reduction comparable to carvedilol in heart failure 1.
Never use mathematical conversion alone—clinical response, heart rate, blood pressure, and symptom control must guide final dosing regardless of theoretical equivalency 1.
Monitoring After Conversion
When switching between beta-blockers at equivalent doses: