Description and Brand NamesBefore UsingProper UsePrecautionsSide Effects Avelable Brandfrom Medikaloka Apotheca : V-Bloc US Brand Name Coreg Coreg CR Descriptions Carvedilol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled. Carvedilol is also used to prevent further worsening of congestive heart failure. It is also used to treat left ventricular dysfunction after a heart attack. Left ventricular dysfunction occurs when the left ventricle (the main pumping chamber of the heart) stiffens and enlarges and can cause the lungs to fill with blood. Carvedilol belongs to a group of medicines called beta-adrenergic blocking agents, beta-blocking agents, or more commonly, beta-blockers. Beta-blockers work by affecting the response to some nerve impulses in certain parts of the body. As a result, they decrease the heart’s need for blood and oxygen by reducing its workload. They also help the heart to beat more regularly. Carvedilol may also be used for other conditions as determined by your doctor. This medicine is available only with your doctor’s prescription. This product is available in the following dosage forms: Tablet Capsule, Extended Release In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered: Allergies Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Pediatric Appropriate studies have not been performed on the relationship of age to the effects of carvedilol in the pediatric population. Safety and efficacy have not been established. Geriatric Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of carvedilol in the elderly. Pregnancy Information about this carvedilol-oral-route Pregnancy Category Explanation All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women. Breastfeeding There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Drug Interactions Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Colchicine Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Afatinib Albuterol Amiodarone Arformoterol Bambuterol Bosutinib Bupropion Clenbuterol Colterol Crizotinib Dabigatran Etexilate Diltiazem Doxorubicin Doxorubicin Hydrochloride Liposome Dronedarone Epinephrine Everolimus Fenoldopam Fenoterol Fingolimod Fluoxetine Formoterol Hexoprenaline Indacaterol Iobenguane I 123 Isoetharine Levalbuterol Metaproterenol Morphine Morphine Sulfate Liposome Nilotinib Olodaterol Pirbuterol Pixantrone Pomalidomide Procaterol Reproterol Ritodrine Romidepsin Salmeterol Terbutaline Topotecan Trabectedin Tretoquinol Tulobuterol Verapamil Vilanterol Vincristine Vincristine Sulfate Liposome Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Acarbose Aceclofenac Acemetacin Acetohexamide Acetyldigoxin Alfuzosin Amlodipine Amtolmetin Guacil Arbutamine Aspirin Benfluorex Bromfenac Bufexamac Bunazosin Celecoxib Chlorpropamide Choline Salicylate Cimetidine Clonixin Deslanoside Dexibuprofen Dexketoprofen Diclofenac Diflunisal Digitoxin Digoxin Dipyrone Dobutamine Doxazosin Etodolac Etofenamate Etoricoxib Felbinac Felodipine Fenoprofen Fepradinol Feprazone Floctafenine Flufenamic Acid Flurbiprofen Gliclazide Glimepiride Glipizide Gliquidone Glyburide Guar Gum Ibuprofen Ibuprofen Lysine Indomethacin Insulin Insulin Aspart, Recombinant Insulin Glulisine Insulin Lispro, Recombinant Ketoprofen Ketorolac Lacidipine Lercanidipine Lornoxicam Loxoprofen Lumiracoxib Manidipine Meclofenamate Mefenamic Acid Meloxicam Metformin Metildigoxin Mibefradil Miglitol Morniflumate Moxisylyte Nabumetone Naproxen Nepafenac Nicardipine Nifedipine Niflumic Acid Nilvadipine Nimesulide Nimodipine Nisoldipine Nitrendipine Oxaprozin Oxyphenbutazone Parecoxib Phenoxybenzamine Phentolamine Phenylbutazone Piketoprofen Piroxicam Pranidipine Pranoprofen Prazosin Proglumetacin Propyphenazone Proquazone Repaglinide Rifampin Rifapentine Rofecoxib Salicylic Acid Salsalate Sodium Salicylate St John’s Wort Sulindac Tamsulosin Tenoxicam Terazosin Tiaprofenic Acid Tolazamide Tolbutamide Tolfenamic Acid Tolmetin Trimazosin Troglitazone Urapidil Valdecoxib Other Interactions Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. Other Medical Problems The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially: Angina (severe chest pain) or Bradycardia (slow heartbeat) or Breathing or other lung problems (e.g., bronchitis or emphysema) or Coronary artery disease or Diabetes or Edema (fluid retention or body swelling) or Heart or blood vessel disease or Hyperthyroidism (overactive thyroid) or Hypotension (low blood pressure) or Major surgery, scheduled or Peripheral vascular disease (blood circulation problem) or Pheochromocytoma (adrenal gland tumor)—Use with caution. May make these conditions worse. Asthma or AV block, second or third-degree or Bradycardia (slow heartbeat), severe (without a pacemaker) or Cardiogenic shock (shock caused by heart attack) or Heart failure, decompensated or Hypersensitivity reactions (e.g., anaphylaxis, angioedema, Stevens-Johnson syndrome), history of or Liver disease, severe or Sick sinus syndrome (type of abnormal heart rhythm)—Should not be used in patients with these conditions. Kidney disease or Liver disease—Use with caution. Effects may be increased because of slower removal of the medicine from the body. Low blood sugar (hypoglycemia)—May worsen low blood sugar (hypoglycemia) levels caused by insulin and may delay recovery of blood sugar levels; in patients with diabetes and heart failure, carvedilol may further increase blood sugar levels; in addition, if your diabetes medicine causes your blood sugar to be too low, carvedilol may cover up some of the symptoms (fast heartbeat). In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet. Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well. Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease. This medicine comes with a patient information insert. Read and follow the instructions in the insert carefully. Ask your doctor if you have any questions. You may take this medicine with food. Swallow the extended-release capsule whole. Do not break, crush, or chew it. If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of cold, soft food such as an applesauce. Stir this mixture well and swallow it without chewing. Dosing The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For oral dosage form (extended-release capsules): For heart failure: Adults—At first, 10 milligrams (mg) once a day for at least two weeks. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day. Children—Use and dose must be determined by your doctor. For hypertension: Adults—At first, 20 milligrams (mg) once a day for 7 to 14 days. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day. Children—Use and dose must be determined by your doctor. For left ventricular dysfunction after a heart attack: Adults—At first, 20 milligrams (mg) once a day for 3 to 10 days. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day Children—Use and dose must be determined by your doctor. For oral dosage form (tablets): For congestive heart failure: Adults—At first, 3.125 milligrams (mg) two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 25 or 50 mg two times a day. Children—Use and dose must be determined by your doctor. For high blood pressure (hypertension): Adults—At first, 6.25 milligrams (mg) two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 25 mg two times a day. Children—Use and dose must be determined by your doctor. For left ventricular dysfunction after a heart attack: Adults—At first, 6.25 milligrams (mg) two times a day. Some patients may start at 3.125 mg two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 25 mg two times a day. Children—Use and dose must be determined by your doctor. Missed Dose If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Storage Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed. Ask your healthcare professional how you should dispose of any medicine you do not use. It is important that your doctor check your progress at regular visits to make sure this medicine is working properly and to allow for changes in the dose. This medicine may cause dizziness, lightheadedness, or fainting. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert. Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position suddenly. These symptoms are more likely to occur when you begin taking this medicine, or when the dose is increased. Sitting or lying down may help alleviate these unwanted effects. Before having any kind of surgery (including dental surgery or cataract surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine. A serious eye problem called Intraoperative Floppy Iris Syndrome (IFIS) has occurred in some patients who were taking this medicine or who had recently taken this medicine when they had cataract surgery. For diabetic patients: This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of hypoglycemia (low blood sugar), such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests. For congestive heart failure patients: Check with your doctor if you have unexplained weight gain or increased shortness of breath. These may be signs of a worsening of your condition. For patients who wear contact lenses: Carvedilol may cause your eyes to form tears less than they do normally. Check with your doctor if you have dry eyes. Do not interrupt or stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor immediately if any of the following side effects occur: More common Allergy chest pain, discomfort, tightness, or heaviness dizziness, lightheadedness, or fainting generalized swelling or swelling of the feet, ankles, or lower legs pain shortness of breath slow heartbeat weight gain Less common Ankle, knee, or great toe joint pain anxiety arm, back, or jaw pain blood in the urine bloody, black or tarry stools chills cloudy urine cold sweats coma confusion convulsions cool pale skin cough dark urine decreased appetite decreased frequency or amount of urine depression difficulty with breathing dizziness, faintness, or lightheadedness when getting up suddenly from a lying position dry mouth fainting fast or irregular heartbeat fever flu-like symptoms flushed, dry skin fruit-like breath odor headache, sudden and severe inability to speak increased blood pressure increased hunger increased thirst increased urination itching joint stiffness or swelling large amount of cholesterol in the blood loss of appetite loss of consciousness lower back, side, or stomach pain mental depression muscle pain or cramps nervousness nightmares noisy, rattling breathing numbness or tingling in the hands, feet, or lips pinpoint red or purple spots on the skin pounding in the ears pounding, slow heartbeat rapid breathing seizures shakiness slurred speech stomachache sweating swelling of the fingers or hands temporary blindness tenderness on the upper right side of the body trouble with breathing even at rest unexplained weight loss unusual bleeding or bruising weakness in the arm and/or leg on one side of the body, sudden and severe weakness or heaviness of the legs yellow eyes or skin Incidence not known Sores, ulcers, or white spots on the lips or in the mouth swollen or painful glands wheezing Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: More common Back pain diarrhea prickling or tingling sensation unusual tiredness or weakness Less common Abdominal or stomach pain bleeding gums blurred vision burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings changes in vision cold hands and feet decreased interest in sexual intercourse decreased tearing difficulty with moving feeling of constant movement of self or surroundings general feeling of discomfort or illness headache inability to have or keep an erection increased sweating joint or muscle pain lack or loss of strength loose teeth loss of sexual ability, desire, or performance loss of strength or energy muscle aches, stiffness, or weakness nausea persistent breath odor or bad taste in your mouth redness and swelling of the gums sensation of spinning sleepiness or unusual drowsiness sore throat stuffy or runny nose sugar in the urine trouble sleeping unusual weak feeling vomiting weight loss Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects.