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How does it work?
This medicine contains the active ingredient carvedilol, which is a type of medicine called a beta-blocker.
Beta-blockers block beta-receptors in the heart, lungs and other organs of the body. Blocking these receptors prevents the action of two chemicals called noradrenaline and adrenaline that occur naturally in the body. These are often referred to as the 'fight or flight' chemicals, as they are responsible for the body's reaction to stressful situations.
Carvedilol mainly blocks beta-receptors in the heart, which causes the heart to beat more slowly and with less force. This means that the heart uses less energy and so requires less oxygen from the blood. The pain of angina is caused by not enough oxygen reaching the heart when it's workload is increased, eg during exercise. Carvedilol prevents this pain by decreasing the oxygen demand of the heart, so that it always has a sufficient supply.
Due to the heart beating more slowly and with less force, the pressure at which blood is pumped out of the heart to the rest of the body is reduced. This is one way in which carvedilol reduces blood pressure.
Carvedilol also blocks receptors called alpha-receptors that are present on the walls of blood vessels. Blocking these receptors causes the blood vessels to widen, which means that there is more space and less resistance in the blood vessels. This is another mechanism by which the pressure in the blood vessels is lowered.
The widened blood vessels also allow more blood to reach the heart, which is another way in which carvedilol prevents the pain of angina.
Overall, carvedilol decreases the effort required by the heart to pump blood around the body and so can also be used to treat chronic heart failure, where the pumping action of the heart has become less effective.
Because carvedilol widens the blood vessels and maintains the blood flow to the extremities, it rarely causes the cold extremities (hands and feet) that can occur in people taking other beta-blockers.
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What is it used for?
Angina pectoris
Chronic heart failure
High blood pressure (hypertension)
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Warning!
This medicine may mask the symptoms of low blood sugar such as increased heart rate, tremor and nausea. People with diabetes should carefully monitor their blood sugar.
This medicine may cause fatigue and dizziness. You should take care when performing potentially hazardous activites, such as driving or operating machinery, until you know how this medicine affects you and are sure you can perform such activities safely.
This medicine may mask the symptoms of the condition caused by an excess of thyroid hormone (thyrotoxicosis).
This medicine should not be stopped abruptly, particularly in people with heart disease caused by poor blood flow to the heart (ischaemic heart disease).
Alcohol may enhance the blood pressure lowering effect of this medicine, which may result in dizziness or fainting.
This medicine may increase sensitivity to substances which cause allergy and the seriousness of severe allergic reactions (anaphylaxis). People who experience an anaphylactic reaction while taking this medicine may need larger than normal doses of adrenaline to treat the reaction. Seek further medical advice from your doctor if you have a history of allergy.
The safety of this medicine has not been established in children and adolescents under the age of 18.
Contact lens wearers should be aware that this medicine may cause dry eyes.
People with chronic heart failure should take this medicine with food.
If this medicine causes the heart rate to drop below 55 beats per minute, the dose should be reduced. Consult your doctor.
For the treatment of heart failure, treatment with carvedilol should be started and checked by a hospital specialist. Your heart failure may worsen while taking this medicine, particularly early on in your treatment. This may cause increased symptoms (eg tiredness, shortness of breath) and signs of fluid retention (eg weight gain and swelling of the legs). Consult your doctor if your symptoms or condition worsen as he may need to change the dose of carvedilol or your other medications.
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Use with caution in
A severe form of angina pectoris, not caused by exertion (Prinzmetal's angina)
Decreased kidney function
Diabetes
Disease involving the blood vessels (vascular disease)
History of psoriasis associated with beta-blocker treatment
History of serious allergies
Hyperthyroidism
Narrowing of the blood vessels in the hands, causing numb and painful fingers (Raynaud's disease)
People undergoing therapy to decrease allergy (desensitisation therapy)
Tumour of the adrenal gland (phaeochromocytoma)
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Not to be used in
A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome)
Chronic obstructive pulmonary disease (COPD)
Decreased liver function
Failure of the electrical impulse that causes the heart to beat to leave the pacemaker of the heart, resulting in decreased heart function (sino-atrial heart block)
Failure of the heart to maintain adequate circulation of blood (cardiogenic shock)
History of asthma
History of breathing difficulties due to a narrowing of the airways (bronchospasm)
Increased acid levels in the blood (metabolic acidosis)
Marked fluid retention requiring treatment with intravenous heart medicines (inotropes, eg digoxin)
Serious defect in the heart's electrical message pathways (2nd or 3rd degree heart block), unless an artificial pacemaker is fitted
Slow heart rate of less than 50 beats per minute (bradycardia)
Tumour of the adrenal gland (phaeochromocytoma), unless this is first treated with an alpha-blocker medicine
Very low blood pressure (severe hypotension)
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
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Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
This medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus. Seek medical advice from your doctor.
This medicine may pass into breast milk. For this reason it is recommended that mothers using this medicine should not breastfeed. Seek medical advice from your doctor.
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Label warnings
Do not stop taking this medication except on your doctor's advice.
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Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Headache
Rash
Disturbed sleep
Impotence
Fatigue
Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
Weight gain
Visual disturbances
Blockade of the electrical pathways which control the pumping action of the heart (heart block)
Dizziness
Increased blood cholesterol level
Excessive fluid retention in the body tissues, resulting in swelling (oedema)
Slow heart rate (bradycardia)
A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension)
Wheezing
Weakness or loss of strength (asthenia)
Depressed mood
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
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How can this medicine affect other medicines?
If carvedilol is taken with other medicines that decrease blood pressure, either as their intended action or as a side effect, there may be a risk of a large drop in blood pressure, particularly with the first dose. Alcohol may enhance the blood pressure lowering effect of this medicine, which may result in dizziness or fainting.
In people with diabetes, carvedilol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. Individuals should monitor their blood sugar, as carvedilol can also mask the signs of hypoglycaemia.
Carvedilol may increase the blood levels of the following medicines:
- ciclosporin
- digoxin.
The blood levels of these medicines should be monitored if they are taken with carvedilol.
If carvedilol is taken with digoxin or diltiazem there may be an increased risk of slow heart rate.
If carvedilol is taken with verapamil the risk of slow heart rate and heart block may be increased.
If carvedilol is taken with medicines for abnormal heart rhythms, such as amiodarone or disopyramide, there may be an increased risk of slow heart rate or other adverse effects on the heart.
Antiarrhythmic medicines, verapamil and diltiazem should not be given intravenously (injected into a vein) to people taking this medicine.
If carvedilol is taken with nifedepine and possibly other calcium channel blockers, the risk of a large fall in blood pressure and heart failure may be increased.
The increase in blood pressure that occurs when the medicine clonidine is stopped may be worsened if carvedilol is being taken at the same time. The carvedilol should be stopped several days before slowly withdrawing the clonidine.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as indometacin may reduce the blood pressure lowering effects of carvedilol.
Care should be taken when adrenaline is given with carvedilol, as this combination may cause severe high blood pressure and slow heart rate.
Rifampicin increases the removal of this medicine from the body, which may result in decreased blood levels of carvedilol .
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