Beta-Blocker / HFrEF Pregnancy: Should not be used during pregnancy unless the potential benefit outweighs the potential risk. Beta-blockers reduce placental perfusion (risk of intrauterine foetal death, immature/premature delivery) and may cause hypoglycaemia, hypotension, bradycardia, respiratory depression and hypothermia in the fetus/neonate. Breastfeeding is not recommended.

Carvedilol

Brand names: Eucardic

Used in: Liver Disease & Cirrhosis

Carvedilol is a beta-blocker with additional alpha-blocking (vasodilator) activity, used in heart failure with reduced ejection fraction, and in hypertension and angina.

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: 3.125 mg twice a day for two weeks; if tolerated, increase at intervals of not less than two weeks to 6.25 mg twice a day, then 12.5 mg twice daily, then 25 mg twice daily

Route: Oral

Frequency: Twice daily

Max: 25 mg twice daily for patients with severe CHF and for patients with mild to moderate CHF weighing less than 85 kg; in patients with mild or moderate CHF weighing more than 85 kg, 50 mg twice daily

Symptomatic congestive heart failure indication. Dose must be titrated to individual requirements and monitored during up-titration; dosing should be increased to the highest level tolerated. For patients receiving diuretics and/or digoxin and/or ACE inhibitors, dosing of these other medicinal products should be stabilised prior to initiation. Before each dose increase the patient should be evaluated for symptoms of worsening heart failure or vasodilation. If treatment is discontinued for more than one week, recommence at a lower dose level and up-titrate; if discontinued for more than two weeks, recommence at 3.125 mg twice daily and up-titrate. Give with food to slow absorption and reduce orthostatic effects. As with all beta-blockers, do not stop abruptly; reduce gradually at weekly intervals.

Dose adjustments

Renal

No dose adjustment is needed in moderate to severe renal impairment (per SPC). In CHF patients with low blood pressure, ischaemic/diffuse vascular disease and/or underlying renal insufficiency, renal function should be monitored during up-titration and the medicinal product discontinued or dosage reduced if worsening renal failure occurs.

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.

US labelling (FDA)

Reference — US labelling, may differ from UK

Take with food. Individualize dosage and monitor during up-titration. ( 2 ) Heart failure: Start at 3.125 mg twice daily and increase to 6.25, 12.5, and then 25 mg twice daily over intervals of at least 2 weeks. Maintain lower doses if higher doses are not tolerated. ( 2.1 ) Left ventricular dysfunction following myocardial infarction: Start at 6.25 mg twice daily and increase to 12.5 mg then 25 mg twice daily after intervals of 3 to 10 days. A lower starting dose or slower titration may be used.( 2.2 ) Hypertension: Start at 6.25 mg twice daily and increase if needed for blood pressure control to 12.5 mg and then 25 mg twice daily over intervals of 1 to 2 weeks.( 2.3 ) Carvedilol should be …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-05-11. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

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 (<50 bpm)
Cardiogenic shock
Sick sinus syndrome (including sino-atrial block)
Severe hypotension (systolic blood pressure <85 mmHg)

Side effects

Dizziness (very common)
Headache (very common)
Cardiac failure (very common)
Hypotension (very common)
Asthenia/fatigue (very common)
Bradycardia, oedema (common)

Interactions

Digitalis glycosides (e.g. digoxin) — both slow AV conduction; use with caution
CYP2D6 inhibitors (e.g. quinidine, fluoxetine, paroxetine, propafenone) — expected to increase carvedilol blood levels
Hypotensive agents (e.g. reserpine, MAO inhibitors, clonidine) — increased risk of hypotension and/or severe bradycardia
Amiodarone — may increase carvedilol levels with further slowing of heart rate or 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 β1, β2 and α1 adrenoceptors, reducing heart rate, contractility and afterload; gradual up-titration improves prognosis in heart failure.

Prescribing in practice

In heart failure, start low and up-titrate slowly only when stable and euvolaemic — not during decompensation.
Postural hypotension and dizziness can occur from the alpha-blockade, especially early.
Use caution in asthma, and do not stop abruptly in ischaemic heart disease.

Monitoring

Monitor heart rate, blood pressure (including postural) and heart-failure status during titration.

Counselling the patient

Take it with food to reduce dizziness.
Do not stop it suddenly.
Report worsening breathlessness or swelling.

Evidence & guidelines

A prognostic beta-blocker option in HFrEF within guideline-directed therapy (NICE NG106).

Reference: COPERNICUS Trial (Packer et al. NEJM 2001); CAPRICORN Trial (Lancet 2001); ESC HF Guidelines 2021; SPC Eucardic; 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