Non-cardioselective beta-blocker + alpha-1 blocker Pregnancy: There are no adequate data from use in pregnant women; should not be used during pregnancy unless the potential benefit outweighs the risk. Beta-blockers reduce placental perfusion (possible intrauterine foetal death, immature/premature delivery) and may cause hypoglycaemia, hypotension, bradycardia, respiratory depression and hypothermia in the fetus/neonate, with increased risk of cardiac and pulmonary complications postnatally. Breastfeeding is not recommended following administration.

Carvedilol

Brand names: Eucardic

Carvedilol is a non-selective beta-blocker with additional alpha-1 blocking (vasodilating) activity, used for hypertension, angina and chronic heart failure with reduced ejection fraction.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Symptomatic congestive heart failure: 3.125 mg twice a day for two weeks initially. Hypertension: 12.5 mg once a day for the first two days, thereafter 25 mg once a day

Route: oral

Frequency: twice a day (heart failure); once a day (hypertension)

Max: Heart failure: 25 mg twice daily for severe CHF and for mild-to-moderate CHF weighing less than 85 kg; 50 mg twice daily if mild-to-moderate CHF weighing more than 85 kg. Hypertension: 50 mg daily (once a day or in divided doses)

Congestive heart failure: dosage must be titrated to individual requirements and monitored during up-titration. Stabilise any diuretics, digoxin and/or ACE inhibitors before initiation. If the initial 3.125 mg twice daily is tolerated, increase at intervals of not less than two weeks to 6.25 mg twice daily, then 12.5 mg twice daily, then 25 mg twice daily, to the highest tolerated level. Evaluate for worsening heart failure/vasodilation before each dose increase. If treatment is discontinued for more than one week, restart at a lower dose and up-titrate; if discontinued for more than two weeks, restart at 3.125 mg twice daily. Give with food for CHF patients. Hypertension: dose may be titrated up to a maximum of 50 mg daily, with titration at intervals of at least two weeks; elderly initial dose 12.5 mg. As with all beta-blockers, do not stop abruptly - reduce gradually at weekly intervals.

Dose adjustments

Renal

Pharmacokinetic data and clinical studies in patients with renal impairment (including renal failure) suggest no dose adjustment is needed in moderate to severe renal impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Unstable/decompensated heart failure requiring intravenous inotropic support
Clinically manifest liver dysfunction
History of bronchospasm or asthma
2nd and 3rd degree atrioventricular (AV) heart block (unless a permanent pacemaker is in place)
Severe bradycardia
Cardiogenic shock
Sick sinus syndrome (including sino-atrial block)
Severe hypotension

Side effects

Dizziness, headache (very common)
Asthenia (fatigue), cardiac failure, hypotension (very common)
Bradycardia, oedema, hypervolaemia, fluid overload (common)
Anaemia; weight increase, hypercholesterolaemia, impaired blood glucose control (hyperglycaemia, hypoglycaemia) in patients with pre-existing diabetes (common)
Nausea, diarrhoea, vomiting, dyspepsia, abdominal pain (common); depression, depressed mood (common)

Interactions

Digitalis glycosides (e.g. digoxin): both slow AV conduction - use with caution; digoxin levels may increase
CYP2D6 inhibitors (e.g. quinidine, fluoxetine, paroxetine, propafenone) may increase carvedilol blood levels; rifampin may decrease levels
Hypotensive agents (e.g. reserpine, MAO inhibitors, clonidine) may increase risk of hypotension and/or severe bradycardia
Amiodarone may increase carvedilol levels with further slowing of heart rate/cardiac conduction
Verapamil- or diltiazem-type calcium channel blockers may affect ECG and/or blood pressure; insulin and oral hypoglycaemics action may be enhanced

Clinical monograph

How it works

It blocks beta-1, beta-2 and alpha-1 adrenoceptors, reducing heart rate and contractility while causing peripheral vasodilatation, which lowers blood pressure and, in heart failure, mitigates chronic sympathetic activation.

Prescribing in practice

In heart failure it must be initiated at a low dose in a stable patient and titrated slowly, as rapid increases can transiently worsen failure; do not stop abruptly.
The alpha-blocking effect adds a risk of postural hypotension, particularly with the first dose and after increases.
Use caution in asthma given non-selective beta-blockade, and it may mask hypoglycaemic warning signs in diabetes.

Monitoring

Monitor heart rate, blood pressure and heart failure status, including for fluid retention, during gradual titration.

Counselling the patient

Take with food to reduce the chance of dizziness from a rapid drop in blood pressure.
Do not stop the medicine suddenly without advice.
Report fainting, marked dizziness, wheeze or worsening breathlessness or swelling.

Evidence & guidelines

Carvedilol reduces mortality in chronic heart failure with reduced ejection fraction, demonstrated in the COPERNICUS trial, and is recommended by NICE for heart failure.

Reference: NICE NG106; ESC HF; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways