Carvedilol !
A beta blocker that also blocks α1 receptors, so it widens vessels. A key drug in heart failure with reduced ejection fraction.
Updated 2026-11-01
The figure shows carvedilol bound to the human β2 receptor (fused to a T4 lysozyme for crystallisation); carvedilol blocks β1 and α1 receptors as well.
Mechanism of action
Carvedilol blocks β1 and β2 receptors without selectivity and also blocks α1 receptors on arterioles. The β block slows the heart and lowers renin; the α1 block dilates vessels, so blood pressure and afterload fall without a rise in peripheral resistance. In heart failure, long-term use shields the heart from sympathetic overdrive and reduces deaths.
- Carvedilol blocks β1, β2 and α1 receptors
- β block: slower heart rate and less renin
- α1 block: arterioles dilate and afterload falls
Pharmacokinetics
- Absorption
- Well absorbed but with a large first-pass loss; given with food to slow absorption and limit orthostatic hypotension
- Metabolism
- Liver, largely by CYP2D6
- Half-life
- About 7 to 10 hours
Indications
- Heart failure with reduced ejection fraction Heart failure →
- Left ventricular dysfunction after myocardial infarction Myocardial Infarction (Heart Attack) →
- High blood pressure Arterial hypertension →
Adverse effects
Common
- Dizziness and orthostatic hypotension
- Fatigue
- Bradycardia
- Weight gain and fluid retention
- Higher blood glucose
Contraindications
- Bronchial asthma or related bronchospastic conditions
- Second- or third-degree AV block, sick sinus syndrome or severe bradycardia without a pacemaker
- Cardiogenic shock or decompensated heart failure needing IV inotropes
- Severe liver impairment
Key interactions
- CYP2D6 inhibitors (for example fluoxetine, paroxetine, quinidine)
- Higher carvedilol levels
- Digoxin
- Higher digoxin levels and added slowing of AV conduction
- Verapamil or diltiazem
- Conduction disturbances and hypotension
- Insulin and oral antidiabetics
- Stronger glucose-lowering effect and masked hypoglycaemia
What is monitored
- Heart rate and standing blood pressure
- Weight and signs of fluid retention
- Glucose in diabetes
- Kidney function in heart failure
Administration and safety
- Given by mouth with food, which lowers the risk of orthostatic hypotension
- Started low and raised step by step; withdrawn gradually, never suddenly
- Immediate-release and extended-release forms are not interchangeable one-to-one: the form is checked
Nursing care
- Check pulse and lying and standing blood pressure before doses and during titration
- Weigh daily in heart failure and report a quick gain or new oedema
- Teach the patient to stand up slowly and not to stop the drug abruptly
- Watch for wheezing in patients with lung disease
Pregnancy and breastfeeding
Human data are limited; beta blockers can slow fetal growth and cause bradycardia and hypoglycaemia in the newborn.
Test yourself
Think of the answer, then tap the question to see it.
What does carvedilol block besides β receptors?
α1 receptors on arterioles, which adds vasodilation and explains orthostatic hypotension.
Why is carvedilol given with food?
Food slows its absorption and lowers the risk of orthostatic hypotension.
Can carvedilol be used in a patient with asthma?
No. It is non-selective for β receptors, and bronchial asthma is a contraindication.
Related drugs
Related conditions
← Back to the class: Beta blockers
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - CARVEDILOL tablet, film coated (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.