Start slowly, monitor fluid status, and avoid abrupt withdrawal.
Bradycardia, low BP and transient HF worsening can occur during titration. Asthma/related bronchospasm, major conduction disease and decompensated HF requiring IV inotropes are contraindications. IR and CR doses must be converted using the labeled table.
Warnings and precautionsIndications
Adult indications include chronic HF, post-MI LV dysfunction and essential hypertension.
Labeled oral indications
Both formulations treat mild-to-severe chronic HF of ischemic/cardiomyopathic origin to improve survival and reduce hospitalization alongside appropriate background therapy; reduce cardiovascular mortality after acute MI in clinically stable survivors with LVEF ≤40%, with or without HF; and treat essential hypertension alone or with other agents. Label descriptions of older HF background therapy are not a complete contemporary HF treatment algorithm.
Population and formulation scope
Pediatric effectiveness below 18 years is not established. This reference covers adult immediate-release Coreg tablets and Coreg CR capsules; it does not supply pediatric/off-label regimens or equate CR milligrams to IR milligrams.
Dosage and administration
Dose and titration depend on indication and release formulation.
Immediate-release oral tablets · Adults
Take with food to slow absorption and lessen orthostatic effects. Minimize fluid retention before initiation.
| Indication | Dose / titration |
|---|---|
| Chronic HF | 3.125 mg twice daily for 2 weeks; if tolerated, 6.25, 12.5 then 25 mg twice daily at intervals ≥2 weeks. Label notes 50 mg twice daily has been administered in mild/moderate HF weighing >85 kg; not a universal target. |
| Stable post-MI LV dysfunction | 6.25 mg twice daily, then 12.5 and target 25 mg twice daily at 3–10 day intervals as tolerated. May start 3.125 mg twice daily or titrate more slowly for low BP/HR or fluid retention. |
| Hypertension | 6.25 mg twice daily; after 7–14 days increase to 12.5 then 25 mg twice daily if needed/tolerated. Maximum total 50 mg/day. Check standing BP ~1 hour after dose and trough BP. |
Extended-release Coreg CR · Adults
Take once each morning with food. Swallow intact; alternatively open and sprinkle all beads onto a spoonful of non-warm applesauce, consume immediately without crushing/chewing, and never store the mixture. Other sprinkle foods are untested.
| Indication | Dose / titration |
|---|---|
| Chronic HF | 10 mg daily for 2 weeks; increase to 20, 40, then 80 mg daily at intervals ≥2 weeks if tolerated. |
| Stable post-MI LV dysfunction | 20 mg daily; increase to 40 then target 80 mg daily at 3–10 day intervals. May start 10 mg/slower titration if clinically indicated. |
| Hypertension | 20 mg daily; maintain each step 7–14 days then 40 and 80 mg if needed/tolerated. Maximum 80 mg/day. |
IR → Coreg CR conversion
The labeled conversion uses total daily IR exposure, not a milligram-for-milligram substitution.
| Current IR twice-daily dose | Usual CR once-daily dose |
|---|---|
| 3.125 mg twice daily (6.25 mg/day) | 10 mg daily |
| 6.25 mg twice daily (12.5 mg/day) | 20 mg daily |
| 12.5 mg twice daily (25 mg/day) | 40 mg daily |
| 25 mg twice daily (50 mg/day) | 80 mg daily |
- In older patients or those at greater hypotension/dizziness/syncope risk, switching IR 12.5 or 25 mg twice daily may warrant initial CR 20 or 40 mg respectively, then titration after ≥2 weeks.
- For age ≥65 switching from IR 25 mg twice daily, label specifically recommends initial CR 40 mg.
- No CR conversion is provided here for IR 50 mg twice daily; do not extrapolate beyond the table.
Organ impairment and discontinuation
Severe hepatic impairment is contraindicated. No fixed renal dose adjustment is supplied; exposure can increase and renal deterioration may occur in susceptible HF patients during titration. Reduce dose if pulse falls below 55 beats/min. When stopping is planned, taper over 1–2 weeks when possible with observation and reduced activity rather than abrupt withdrawal.
Safety
Bradycardia, hypotension and fluid retention guide safe initiation.
Warnings and precautions
- Abrupt beta-blocker withdrawal may provoke angina, MI or arrhythmia; avoid sudden discontinuation even when coronary disease is unrecognized.
- Pulse <55 requires dose reduction. Dizziness, orthostasis or syncope can occur during initiation/increases; take with food and avoid hazardous activities until response is known.
- Worsening HF/fluid retention requires stabilization and review of diuretic/carvedilol doses before further titration. Follow renal function in susceptible HF patients, especially low systolic BP <100, vascular disease or renal insufficiency.
- Asthma/related bronchospasm is contraindicated; other bronchospastic disease generally should not receive beta blockers, with exceptional cautious use only when alternatives cannot be tolerated.
- May mask hypoglycemia warning tachycardia and increase severe/prolonged hypoglycemia risk, particularly during fasting or diabetes treatment. Monitor glucose with dose initiation/change/discontinuation.
- Use caution with peripheral vascular disease, thyrotoxicosis, suspected pheochromocytoma (alpha blockade first) or variant angina. Prior severe allergy may be more reactive and less responsive to usual epinephrine.
- Notify surgery/anesthesia and cataract teams: chronic beta blockade is not routinely withdrawn before major surgery; floppy iris syndrome may complicate cataract procedures.
Contraindications
Bronchial asthma/related bronchospastic disease; second-/third-degree AV block; sick sinus syndrome; severe bradycardia (unless a permanent pacemaker is in place); cardiogenic shock or decompensated HF requiring IV inotropes; severe hepatic impairment; and prior serious carvedilol/product hypersensitivity, including anaphylaxis, angioedema or Stevens–Johnson syndrome.
Boxed warning status
The selected current Coreg and Coreg CR labels do not contain a boxed warning. Cessation-of-therapy risks are prominent section 5.1 warnings; avoid describing them as absent simply because they are not boxed.
Adverse reactions and overdose
Reported effects include dizziness, fatigue, hypotension, bradycardia, diarrhea, weight increase and hyperglycemia, varying by trial/indication. Serious postmarketing reactions include hypersensitivity and severe skin reactions. Overdose can cause profound bradycardia/hypotension, shock, cardiac arrest, bronchospasm or seizures and needs emergency monitored treatment; do not apply home antidote instructions.
Drug interactions
Exposure and additive cardiac effects drive interaction monitoring.
Clinically relevant interactions
| Combination | Action |
|---|---|
| Digoxin | Rate/conduction effects add; digoxin levels can rise. Monitor concentration and bradycardia at carvedilol start/change/stop. |
| Verapamil / diltiazem; amiodarone / CYP2C9 inhibitors | Monitor ECG, HR and BP; conduction/bradycardia or increased beta blockade may occur. |
| CYP2D6 inhibitors such as fluoxetine, paroxetine, quinidine, propafenone | May increase exposure, particularly alpha-blocking enantiomer; monitor dizziness/BP/rate. |
| Rifampin / cimetidine | Exposure can decrease/increase respectively; reassess clinical response/tolerance. |
| Cyclosporine | Check trough levels closely after carvedilol starts; individual adjustment may be needed. |
| Clonidine / catecholamine-depleting agents | Hypotension/bradycardia may increase. If both clonidine/beta blocker are being stopped, clinician stops beta blocker first, then tapers clonidine several days later. |
| Insulin / oral glucose-lowering agents | Glucose lowering may increase and warning symptoms may be masked; monitor glucose regularly. |
| Anesthetic agents; other BP-lowering drugs | Review additive myocardial depression/hypotension with clinical team. |
Use in specific populations
Age, pregnancy and impaired hepatic/renal function require individualized decisions.
Pregnancy and lactation
Human pregnancy data are insufficient to determine developmental risk; untreated hypertension also poses risk. Third-trimester beta blockers can cause neonatal hypotension, bradycardia, hypoglycemia or respiratory depression; monitor exposed infants. Human milk/infant-effect data are absent; balance breastfeeding benefits, maternal need and potential infant effects.
Pediatric and geriatric considerations
Effectiveness below 18 years is not established; a pediatric HF trial did not show a significant outcome benefit. Older adults may be more sensitive to dizziness/hypotension; use conservative CR conversion from higher IR doses and titrate after at least 2 weeks when switching.
Hepatic and renal impairment
Severe cirrhosis increases carvedilol levels approximately 4–7 fold and is contraindicated. Moderate/severe renal impairment can increase IR exposure; the label supplies no fixed renal adjustment. Monitor renal function during titration in high-risk HF and reduce/stop if deterioration develops. Hemodialysis does not substantially remove protein-bound carvedilol.
Clinical pharmacology
Alpha-1 vasodilation accompanies nonselective beta blockade.
Mechanism of action and pharmacodynamics
Carvedilol blocks beta receptors and alpha-1 receptors, reducing heart rate/renin activity and peripheral resistance. Both enantiomers have alpha-1 blockade; beta blockade resides principally in S(-). HF benefit involves neurohormonal and hemodynamic effects and is not fully defined by one mechanism.
Pharmacokinetics
- IR absorption
- Extensive absorption with first-pass metabolism; absolute bioavailability ~25–35%. Food slows absorption without a major extent change.
- CR absorption
- Slower/prolonged absorption; peak ~5 hours. Exposure matches IR at the labeled corresponding conversion doses when both are taken with food.
- Metabolism
- Extensive hepatic oxidation/conjugation, principally CYP2D6/CYP2C9.
- Elimination / binding
- IR terminal half-life generally 7–10 hours; >98% protein-bound, mainly biliary/fecal metabolite elimination, <2% unchanged urine.
Monitoring and counseling
Follow BP, pulse, fluid status and renal response during titration.
Monitoring parameters
- Check resting/standing BP and pulse, dizziness/syncope and dose tolerance. For hypertension, assess trough BP and standing BP ~1 hour after dosing.
- Follow weight, edema, breathlessness and HF stability; stabilize fluid retention before titration.
- Monitor renal function in susceptible HF during increases; follow glucose when diabetes treatment or carvedilol doses change.
- Review ECG/conduction with interacting rate-slowing drugs and digoxin/cyclosporine levels as relevant.
Patient counseling information
- Take with food and follow IR twice-daily versus CR once-morning directions. Do not crush/chew CR beads; use only label-directed applesauce administration.
- Do not stop abruptly; contact the prescriber about tapering. Follow missed-dose instructions and do not double doses.
- Report fainting, very slow pulse, worsening edema/breathlessness, wheezing or serious allergy promptly. Rise carefully and avoid driving when dizzy.
- Tell surgical/cataract teams about carvedilol; discuss diabetes/low-glucose recognition.
Product identification
Verify release formulation, strength and exact product imprint.
Representative oral product · Coreg 6.25 mg
- Dosage form / strength
- Film-coated immediate-release tablet · 6.25 mg
- Labeler
- Waylis Therapeutics LLC
- Appearance / imprint
- White, oval TILTAB · 4140 / WP
- Example NDC
- 80725-140-20 · 100 tablets
Dosage forms and strengths
Coreg IR tablets: 3.125, 6.25, 12.5 and 25 mg. Coreg CR capsules: 10, 20, 40 and 80 mg carvedilol phosphate presentations. CR 10 mg is white/green with GSLGK / 10 mg; other strengths differ. Generic products may have different appearance or sprinkle instructions; verify the supplied label.
Storage and handling
Selected Coreg tablets: below 30°C, protect from moisture, dispense tight/light-resistant. Selected Coreg CR capsules: 25°C with excursions 15–30°C, tight/light-resistant container. Do not save a sprinkled CR/applesauce mixture; consume immediately. Keep out of children’s reach.
References
Original sources for the clinical and product information.
- DailyMed / National Library of MedicineCoreg · immediate-release carvedilol tablets
Full public manufacturer label and patient instructions; SPL version 3, effective 20260731. Product-specific directions reviewed October 1, 2026.
- DailyMed / National Library of MedicineCoreg CR · carvedilol phosphate extended-release capsules
Full public manufacturer label and patient instructions; SPL version 3, effective 20250425. Product-specific directions reviewed October 1, 2026.