Non-cardioselective beta-blocker + alpha-1 blocker

Carvedilol

Brand names: Eucardic

Adult dose

Dose: HF: start 3.125mg BD, double q2w to 25–50mg BD per tolerance; Hypertension: 12.5mg OD, increase to 25mg OD (max 50mg OD)

Route: Oral

Frequency: OD–BD with food

Clinical pearls

NICE NG106 HF: prognostic beta-blocker (with bisoprolol, nebivolol)
ESC HF: titrate to maximum tolerated dose
Take with food to reduce orthostatic hypotension

Contraindications

Severe asthma / COPD
Decompensated heart failure (do not initiate)
Severe bradycardia / heart block
Cardiogenic shock
Severe hepatic impairment
Phaeochromocytoma (without alpha-block)
Hypersensitivity

Side effects

Hypotension (start low, go slow)
Bradycardia
Bronchospasm
Fatigue
Hypoglycaemia masking
Erectile dysfunction

Interactions

Verapamil/diltiazem (bradycardia)
Insulin/oral hypoglycaemics
Other antihypertensives
Strong CYP2D6 inhibitors

Monitoring

BP (sit/stand)
HR
Symptoms
Renal function
Weight (HF)

Reference: BNF; NICE NG106; ESC HF; https://bnf.nice.org.uk/drugs/carvedilol/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways