Maximum Dose of Carvedilol (Coreg)
The maximum daily dose of carvedilol is 50 mg twice daily (100 mg total per day) for both hypertension and chronic heart failure, regardless of body weight. 1
Standard Dosing by Indication
Hypertension
- Starting dose: 6.25 mg twice daily 1
- Target dose: 25 mg twice daily 1
- Maximum dose: 50 mg twice daily (100 mg total daily) 1
- Titration should occur every 1-2 weeks based on blood pressure response 1
Chronic Heart Failure
- Starting dose: 6.25 mg twice daily 1
- Target dose: 25 mg twice daily for patients <85 kg; 50 mg twice daily for patients ≥85 kg 1
- Maximum dose: 50 mg twice daily (100 mg total daily) regardless of weight 1
- The MOCHA trial demonstrated dose-related efficacy, with 25 mg twice daily showing greater benefit than 6.25 mg twice daily 1
- Only 40-70% of patients tolerate maximal doses in protocol-driven titration studies 1
Body Weight Considerations
Body weight does NOT change the maximum allowable dose—it only affects the target dose for heart failure. 1
- Patients <85 kg: Target 25 mg twice daily for heart failure 1
- Patients ≥85 kg: Target 50 mg twice daily for heart failure 1
- Both groups have the same maximum ceiling of 50 mg twice daily 1
Clinical Evidence Supporting Dosing
- The COPERNICUS trial used carvedilol up to 25 mg twice daily and demonstrated a 38% mortality reduction at 12 months in severe heart failure 1
- The COMET trial showed 17% greater mortality reduction with carvedilol (mean dose 42 mg/day) compared to metoprolol tartrate 1
- In real-world practice, mean daily carvedilol dose equivalents are only 25-28 mg versus target doses of at least 50 mg 1
Formulation Differences
- Immediate-release (IR): Dosed twice daily, reaches peak concentration faster 2
- Controlled-release (CR): Once-daily dosing, delays peak concentration by 3.5 hours but maintains equivalent 24-hour beta-blockade 2
- CR formulation: Maximum 80 mg once daily (equivalent to IR 25 mg twice daily) 2
- Fewer adverse events reported with CR formulation (59.1%) versus IR (77.5%), particularly less dizziness and headache 2
Common Pitfalls
- Do not exceed 50 mg twice daily even in patients >85 kg—this is the absolute maximum, not a weight-adjusted target 1
- Titrate gradually every 1-2 weeks to assess tolerance; rapid escalation increases adverse events 1
- Most patients in clinical practice receive sub-target doses (25-28 mg/day) when evidence supports higher doses for optimal outcomes 1
- Carvedilol's alpha-blocking properties may cause postural hypotension and dizziness, particularly early in therapy 3, 4
Tolerability Profile
- Adverse events are dose-related and typically occur early in therapy 3
- Most common: postural hypotension, dizziness, headache, dyspnea, bradycardia, fatigue 3, 4
- Only 7% of patients withdrew due to adverse events in postmarketing surveillance 4
- Carvedilol appears to have less frequent adverse events than other beta-blockers 3