Article Highlights
- Coreg is a medication used for the treatment of high blood pressure and heart failure.
- By blocking the effect of adrenaline, Coreg slows the heart’s pumping action and lowers blood pressure.
- Coreg, usually taken twice daily and with food, comes in tablets from 3.125 to 25 mg, and capsules from 10 to 80 mg.
- Common side effects include dizziness, nausea, headache, and vision changes.
Overview
Carvedilol is a beta blocker, a type of medication that lowers blood pressure by reducing arterial tension and slowing heart rate, thus improving the flow of blood.
Coreg, the brand name for the generic Carvedilol drug, was approved by the Food and Drug Administration (FDA) in 1995 for the treatment of:
- Hypertension: High blood pressure that occurs when the blood’s pressure against the arterial walls is higher than normal
- Heart failure: Occurs when the heart’s pumping action isn’t getting a normal amount of blood to the various parts of the body
- Post-heart attack: Prescribed to patients after they’ve had a heart attack to improve their chance of survival when their heart is not pumping adequately
Carvedilol, available in tablets and extended-release capsules, is frequently prescribed in conjunction with other medications.
How Coreg and Beta Blocker Drugs Work
Coreg belongs to a class of medicines known as beta blockers. These drugs work by obstructing the impact of the hormone adrenaline (or epinephrine), which causes the heart to beat faster and blood pressure to rise. By causing the heart to beat more slowly and with reduced strength, blood pressure is decreased.
Hypertension is a very common condition, in both industrialized nations as well as developing countries. The American Heart Association estimates that there are some 76 million U.S. citizens age 20 and above, i.e. one in 3 adults, who have high blood pressure.
Beta blocker drugs, commonly prescribed in combination with other medications, are used for the treatment of the following conditions:
- High blood pressure
- Irregular heartbeat (arrhythmia, i.e. when the heart beats too fast or too slow or irregularly, feeling like palpitations or fluttering)
- Chest pain (possibly a tight, squeezing, or crushing sensation, or sharp, dull, burning, stabbing sensation)
- Congestive heart failure (which occurs when there’s a reduction in blood flow to the body and a clogging of blood into the lungs and other parts of the body)
- Heart attack (Heart attacks happen when blood flow to the heart is blocked)
- Hyperthyroidism (overactive thyroid)
- Glaucoma (considerable high pressure in one or both eyes that can injure the optic nerve)
- Migraines (intense headache)
- Tremors
- Anxiety disorders (severe and persistent stress)
If left untreated, high blood pressure can lead to stroke, heart failure, kidney failure, arterial disease and retinal problems.
Carvedilol Dosage Information
Carvedilol comes in the following forms and dosage:
Tablet
- 3.125mg
- 6.25mg
- 12.5mg
- 25mg
Capsule, extended release
- 10mg
- 20mg
- 40mg
- 80mg
Coreg is not recommended for children under the age of 18. For adults, the drug is usually started at 3.125mg twice a day, with the potential of increasing the dose every two weeks (when it is well tolerated) to the higher dosages up to 25mg twice daily. Patients weighing over 187 lbs. can be given the maximum dosage of 50mg twice daily for mild to moderate heart failure. Dizziness may preclude such patients undertaking hazardous tasks including driving and using industrial machinery, until the dizziness dissipates and they feel back to their normal state of alertness.
Carvedilol should be taken with food to slow the rate of the drug’s absorption and reduce the incidence of orthostatic or postural hypotension, which is a form of low blood pressure that occurs when standing from a sitting position.
Dosage must be prescribed individually, depending on each patient’s overall health condition, medical history, and other determinants, and it should be closely monitored by the patient’s health care professional, particularly during up-titration (the gradual increase of a drug until it reaches the desired longer-term dosage).
Furthermore, when Coreg treatment is started, or when there are drug dosage increases, patients may experience temporary feelings of dizziness within an hour or so of administering the medication.
Potential Coreg Side Effects
Many people using this drug do not experience serious side effects. If your health care professional prescribes this medication for you, they likely feel that its benefits outweigh its risks of side effects. However, if you experience discomfort or any concerning symptoms after starting this drug, talk to your doctor.
Common Side Effects of Carvedilol Can Include:
- Vision changes
- Changes in sex drive
- Dizziness, nausea, diarrhea
- Weakness
- Headache
Serious Side Effects of Carvedilol Can Include:
- Rapid weight gain
- Chest tightness and pain, wheezing
- Low or uneven heartbeats
- Difficulty breathing, shortness of breath
- Loss of bladder control, difficulty urinating
- Swelling
More Concerning Side Effects (see a physician promptly):
- Symptoms of allergic reaction (swelling of the face, lips, and tongue, or hives and difficulty breathing)
- Skin rash that spreads, especially on the face or upper body
- Skin blistering, peeling, and pain
- Sudden and unexplained shortness of breath
- Rapid heart beat
- Numbness or feeling cold in extremities
- Pale and dry skin, dry mouth
- Lightheadedness, drowsiness, and trouble focusing
- Severe skin reaction
- Fever
- Sore throat
- Burning eyes, blurred vision
- Increased thirst
- Hunger and changes in weight (mostly weight loss)
- Fruity breath odor
Carvedilol Interactions with Other Drugs
The following list includes only a few of the many drugs that interact with carvedilol:
- Antidepressant medications, such as Elavil, Prozac, Zoloft, Cymbalta, and various other drugs
- Heart or blood pressure medications, such as Norvasc, Catapres, Cartia, and many other drugs
- Medicines to treat nausea and vomiting, such as Reglan or Phenergan or others
- Skin testing drugs for allergies
- Tagamet (cimetidine)
- Gengraf, Neoral, and other drugs (cyclosporine)
- Fluconazole (Diflucan)
- Insulin or oral diabetes medication
- Rifampin (Rifadin, Rifater, Rifamate)
- Heart rhythm drugs, such as Cordarone, Pacerone, digitalis, and others
- HIV or AIDS drugs, such as Rescriptor, Norvir, or Kaletra
- Medications that treat psychiatric disorders, such as Thorazin, Haldol, Mellaril, and others
Check with your doctor or pharmacist to determine if there can be negative interactions between any other medications you are taking and carvedilol.
Carvedilol Warnings
Get emergency help if you feel unusual and persistent sweating, difficulty breathing, irregular or fast heartbeat, shortness of breath, pain or tightness, or pain that spreads to your jaw, neck, or arm.
Avoid taking carvedilol if you have severe liver complications or various types of heart conditions that your health care professional will advise you against. Let your doctor know before taking carvedilol if you have:
- Low blood pressure
- A feeling that you might pass out
- Allergies, particularly an allergy to the elements in carvedilol
- Heart rhythm problems, such as a slow or irregular heartbeat
- Sick sinus syndrome (SSS), which is a group of abnormal heart rhythms (arrhythmias) resulting from a malfunction of the heart’s primary pacemaker known as the sinus node
- Asthma, emphysema, chronic bronchitis (OCPD)
- Liver or kidney disease
- A certain type of tumor known as pheochromocytoma
- A certain muscle disease known as myasthenia gravis
- Certain eye problems such as cataracts or glaucoma
- Ongoing or have a history of blood flow problems in your legs and feet
- Diabetes or other low blood sugar issues (Coreg may make it more difficult to control or manage your blood sugar levels)
- Excessive thyroid hormone in your system (hyperthyroidism)
- Sudden and unexplained chest pain when you are in a resting position
- Pending surgery or dental surgery
Pregnancy and Carvedilol:
Studies regarding Coreg and pregnancy and breastfeeding have not been conclusive. It is not clear whether this medication would harm the offspring through breastfeeding. In the absence of such evidence, the best course of action is to allow your health care professional to counsel you as to the best medication for your condition.
Once you are on carvedilol, you should not stop taking it or change the dosage that was prescribed for you without first consulting with your health care professional. If your doctor decides to lower your dosage of Coreg, it would be good for you if you abstained from arduous physical activity to reduce the stress on your heart.
Risk Factors for High Blood Pressure
The following risk factors can raise your odds of developing hypertension:
Aging:
As you age, your chances of developing high blood pressure increase. This increased risk applies in particular to men age 45 or older High blood pressure is more common in men who are 45 years of age and older, and women who are 65 years of age or older.
Race:
African-American adults are more likely to have high blood pressure than Caucasian or Hispanic-American groups. In African-Americans, high blood pressure is also likely to be more severe and acquired at an earlier age.
Genetics:
Hypertension has a pattern of running in families, and having a family history of high blood pressure can put you at greater risk as well.
Birth control:
Women who take birth control pills are at greater risk of developing high blood pressure.
Obesity:
The greater your weight, the more your body tissues will need oxygen and nutrients, the higher the circulation of blood in your veins, and the higher the blood pressure against your arterial walls. Abdominal obesity also increases arterial tension, causing high blood pressure.
Lack of exercise:
A sedentary lifestyle is often associated with increased heart rate and type 2 diabetes, and the higher your heart rate, the more pressure your heart has to exert.
Tobacco use:
Every time you smoke tobacco products (or any other stimulating substances such as coffee or cocaine), you increase the flow of the adrenaline hormone, a powerful stimulant, causing your blood pressure to rise, even if only temporarily. Besides, certain chemicals in tobacco cause your arterial walls to constrict, thus also increasing your blood pressure.
Alcohol consumption:
Men drinking more than two alcohol drinks per day, and women consuming more than one drink a day, are at greater risk for hypertension.
High blood pressure in children:
Children in their teens are becoming more prone to high blood pressure difficulties. Africa-American and Mexican-American children are more likely to be affected by hypertension than their Caucasian counterparts. In addition, boys are at greater risk than girls. Obesity in children and other lifestyle patterns are the main culprits for this worrisome pattern.
Dietary habits:
Remember the old adage, “You are what you eat?” Well, what you ingest is directly linked to your chances for developing high blood pressure. Be aware of the following unhealthy items, particularly when consumed regularly and in excessive quantities:
- Too much sodium (salt) causes your body to retain fluid, which increases blood pressure.
- Since potassium helps balance the amount of sodium in your cells, not getting enough potassium can lead to too much sodium in your blood.
- Low levels of vitamin D; this vitamin impacts an enzyme created by the kidney that affects blood pressure, thus having decreased levels of vitamin D can be harmful.
Stress:
Stress:
Stress causes the release of the powerful stimulant hormones cortisol and adrenaline, which increase heart rate and blood pressure. Furthermore, when these hormones are allowed to linger and persist in the system, as a result of chronic stress, they cause increased injury to various body systems. In addition, to alleviate the preponderance of stress, many people resort to alcohol, smoking or over-eating, all of which are harmful.
Helena’s story of heart failure
Helena, a 49-year old telephone company assistant manager in Michigan, knew everything there was to know about her family history of obesity, type 2 diabetes, and high blood pressure. In fact, she blamed her physical failings, including her unseemly and lumbering overweight, squarely on precisely that, saying to whomever would listen, “Hey, all that was inevitable knowing what my mother, uncles and aunts handed me down.”
To the casual observer, Helena seemed entirely resigned, though not unduly unhappy, to her so-called predestined, etched-in-stone, and unmovable predicament. Although her weight issue bothered her endlessly, as did her troubled breathing, neither that nor her diabetes or hypertension worried her much. She thought of them as long-term issues, stuff to worry about “later”. Within herself though, and at times of inner crisis and turmoil, Helena was scared stiff that her heart condition would have her one day wake up stone dead.
On one particular day, Helena’s nonchalant attitude changed drastically, and it changed for good. She’d been watching a health program on television when suddenly the program showed a heart pumping away furiously, obviously malfunctioning, followed by a 3D animation of the heart troubled by blood congestion in the lungs and again pumping at a terrifying fast rate. The animation showed colored parts of the chest displaying the affected areas -with dark and menacing crimson red all around the heart. For some reason, it was this animation, rather than the real thing, that made her own heart pump with a sudden rush of adrenaline. She even experienced extreme shortness of breath at that moment, and although she’d had such difficulty breathing often enough in the past, it was more pronounced this time and shook her to the core as she panted for breath.
Her life changed significantly from that point on. She went back to her doctor, the same doctor who’d diagnosed her with heart failure three years earlier, and shared her determination to start looking after herself. He printed on his computer a copy of the Dash Diet and gave it her, advising her that it was the best diet for weight control, and for lowering her blood pressure. In the one month that followed, she managed to lose 17 lbs. and another 15 lbs. in the subsequent month, and she started taking short walks at first, and then up to a daily mile after that. What was almost instantly rewarding was that her breathing issues seemed to have dissipated noticeably, and her wheezing had nearly gone altogether.
At the time of her resolve, her doctor also increased her maintenance dose of the beta blocker drug Coreg from 20mg twice daily to 40mg twice daily. He advised her she might experience some resulting dizziness, and that she should not drive until she got accustomed to and tolerated her new dose.
Helena took to the Dash diet like a mouse to nuts. She continued with it, preparing herself daily meals with very little or no sodium at all and, together with her increased dosage of Coreg and regular exercise, the results were more than simply gratifying. She had undergone a 180-degree change in attitude, greatly relishing what years she had left in her.
Over the months that followed, Helena lost more than 60 lbs., and her heart rate dropped to a more reasonable level. She also started breathing almost normally again. These results compounded her resolve, giving her daily reinforcement for the new lifestyle she’d carved for herself. She seemed on the way to recovery from her heart issues as well, although her cardiologist kept pressing her to continue with her healthy regimen and to keep taking her Coreg. He told her that she would probably have to take this beta blocker for the rest of her life.
Final Thoughts
.As with many diseases and health outcomes, the most effective strategy is prevention. While it is comforting to know that there are medications such as Coreg that can help, there are also many lifestyle changes people can make to lower or control blood pressure. Losing weight is typically one of the most effective things you can do to lower blood pressure. Other things you can do are exercise regularly, maintain a healthy diet (such as the DASH diet), limit the amount of sodium and alcohol you consume, stop smoking, cut back on caffeine intake, and try to manage and reduce your stress. There is evidence that behavioral changes like taking up meditation can help reduce blood pressure in stressed individuals. Finally, social support is also linked to lower blood pressure and better health all around. Therefore, in addition to being healthy and active, make sure you keep up your social activity as well, surrounding yourself with people who are supportive.