see also beta blockers

• long term Rx with carvedilol was shown to reduce mortality in systolic heart failure as well as reducing symptoms & improving well-being. Carvedilol also has anti-oxidant, antiproliferative & anti-endothelin properties.
• introduced in Australia in 1997-98
• Carvedilol is a beta blocker with:
  • direct vasodilating actions (including selective alpha adrenergic antagonism) which offset its negative inotropic effect and thus is used in pts with mild-moderate (NYHA Class II & III) congestive cardiac failure.
  • membrane stabilising properties & other effects (antioxidant)
  • but NO intrinsic sympathomimetic effects
• In pts with CCF:
  • acute effects were:
    • reduced: BP, pulm.art.press, pulm.cap.wedge press., heart rate;
    • minimal change to: cardiac output, SV index & systemic vascular resistance
  • chronic effects:
    • as for acute effects but SV index increased
    • decreased LV size

• stabilise pt's CCF FIRST then start slow as may initially worsen symptoms for 1st 3-10wks
• 3.125mg bd for 2wks then double dose every 2wks after assessing pt
• optimal dose is 25mg bd for pts < 85kg or 50mg bd for pts > 85kg
• take with food to reduce risk of orthostatic effects