Is carvedilol a statin. Carvedilol: A Comprehensive Guide to This Vital Heart Medication
What is carvedilol used for. How does carvedilol work. What are the key facts about carvedilol. Who can take carvedilol. How should carvedilol be taken. What are the side effects of carvedilol. How does carvedilol compare to other heart medications.
Understanding Carvedilol: A Powerful Beta Blocker for Heart Health
Carvedilol is a crucial medication in the arsenal of treatments for various heart-related conditions. As a beta blocker, it plays a vital role in managing high blood pressure and preventing serious cardiovascular events. But what exactly is carvedilol, and how does it work to protect your heart?
Carvedilol functions by slowing down the heart rate and making it easier for the heart to pump blood throughout the body. This dual action helps reduce the workload on the heart, ultimately leading to better cardiovascular health. The medication is primarily used to treat hypertension (high blood pressure) and is often prescribed to prevent heart disease, heart attacks, and strokes.
In addition to its primary uses, carvedilol can be combined with other medications to treat heart failure and prevent angina-related chest pain. Its versatility in addressing multiple cardiac issues makes it a valuable tool for healthcare professionals in managing heart health.
Key Benefits of Carvedilol
- Lowers blood pressure
- Reduces risk of heart attacks and strokes
- Helps manage heart failure
- Prevents angina-related chest pain
- Improves overall heart function
Essential Facts About Carvedilol: What Patients Need to Know
When considering carvedilol as a treatment option, it’s crucial to understand some key facts about this medication. How quickly does it start working? What should patients expect in terms of its effects?
Carvedilol typically begins to take effect approximately one hour after ingestion. However, it’s important to note that the full therapeutic benefits may not be realized for days or even weeks. This gradual onset of action allows the body to adjust to the medication, reducing the likelihood of sudden side effects.
Patients are usually prescribed carvedilol to be taken once or twice daily, depending on their specific condition and dosage requirements. Consistency in taking the medication as prescribed is crucial for maintaining its effectiveness.
Important Considerations for Carvedilol Use
- Do not stop taking carvedilol suddenly, as this can worsen your condition
- The medication may cause dizziness or fatigue, especially when first starting treatment
- Regular follow-ups with your healthcare provider are essential to monitor the medication’s effectiveness
- Inform your doctor of any other medications or supplements you’re taking to avoid potential interactions
Who Can Benefit from Carvedilol Treatment?
While carvedilol is a highly effective medication for many individuals with heart-related issues, it’s not suitable for everyone. Who are the ideal candidates for carvedilol treatment, and who should avoid this medication?
Carvedilol can be prescribed to most adults with hypertension, heart failure, or those at risk of cardiovascular events. In some cases, specialists may also prescribe it for children aged 2 years and older, though this is less common and requires careful monitoring.
However, certain individuals should exercise caution or avoid carvedilol altogether. These include people with a history of allergic reactions to carvedilol or similar medications, those with severe asthma or lung disease, and individuals with very low blood pressure or a significantly slow heart rate.
Contraindications for Carvedilol Use
- Allergies to carvedilol or other beta blockers
- Severe asthma or COPD
- Uncontrolled heart failure
- Very low blood pressure (hypotension)
- Severe liver problems
- Certain heart rhythm disorders
Proper Administration of Carvedilol: Dosage and Timing
Ensuring the correct administration of carvedilol is crucial for its effectiveness and safety. How should patients take this medication, and what factors influence dosage?
When initiating carvedilol treatment, doctors often recommend taking the first dose just before bedtime. This precaution helps mitigate potential dizziness that some patients may experience. If no dizziness occurs, subsequent doses can typically be taken in the morning.
Consistency in timing is key when taking carvedilol. It’s best to take the medication at the same time each day. For twice-daily regimens, doses should be spaced approximately 10 to 12 hours apart.
Carvedilol tablets should be swallowed whole with water and can be taken with or without food. However, for patients taking carvedilol for heart failure, it’s advisable to take the medication with food to reduce the risk of dizziness or fainting upon standing.
Carvedilol Dosage Guidelines
- High blood pressure: Starting dose of 12.5mg once daily, potentially increasing to 25-50mg daily
- Heart failure: Initial dose of 3.125mg twice daily, gradually increased over several weeks
- Angina: Starting with 12.5mg twice daily, typically increased to 25mg twice daily
Managing Side Effects: What to Expect with Carvedilol
Like all medications, carvedilol can cause side effects in some individuals. What are the most common side effects, and how can patients manage them effectively?
The most frequently reported side effects of carvedilol include headaches, fatigue, and dizziness. These symptoms are often mild and tend to improve as the body adjusts to the medication. It’s important for patients to communicate any persistent or severe side effects to their healthcare provider.
Other potential side effects may include slow heart rate, low blood pressure, and in rare cases, worsening of asthma symptoms. Patients with a history of respiratory issues should be particularly vigilant and report any breathing difficulties to their doctor immediately.
Strategies for Managing Carvedilol Side Effects
- Take the medication with food to reduce the risk of dizziness
- Rise slowly from a sitting or lying position to minimize lightheadedness
- Stay well-hydrated to help maintain blood pressure
- Avoid alcohol, as it can exacerbate dizziness and fatigue
- Report any unusual or severe side effects to your healthcare provider promptly
Carvedilol vs. Other Heart Medications: A Comparative Analysis
In the realm of cardiovascular medications, carvedilol is one of several options available to patients. How does it compare to other heart medications, and what makes it unique?
Carvedilol belongs to the class of medications known as beta blockers, which work by blocking the effects of adrenaline on the heart. Unlike some other beta blockers, carvedilol also has alpha-blocking properties, which can provide additional benefits in terms of blood pressure control and vascular health.
Compared to ACE inhibitors or calcium channel blockers, carvedilol may be particularly effective in patients with certain types of heart failure or those who have experienced a heart attack. However, the choice of medication often depends on individual patient factors and the specific cardiovascular condition being treated.
Advantages of Carvedilol Over Other Heart Medications
- Dual alpha and beta-blocking action
- Potentially fewer metabolic side effects than some other beta blockers
- Effective in a wide range of cardiovascular conditions
- May improve outcomes in certain types of heart failure
Long-term Benefits and Considerations of Carvedilol Therapy
For patients prescribed carvedilol, understanding the long-term implications of this therapy is crucial. What are the potential benefits of extended carvedilol use, and what should patients be aware of over time?
Long-term use of carvedilol has been associated with improved survival rates in patients with heart failure and reduced risk of cardiovascular events in those with hypertension. The medication’s ability to reduce the workload on the heart can lead to better overall cardiac function and quality of life for many patients.
However, it’s important for patients to maintain regular check-ups with their healthcare provider while on carvedilol. Over time, dosage adjustments may be necessary, and monitoring for any changes in kidney or liver function is essential.
Key Considerations for Long-term Carvedilol Use
- Regular blood pressure and heart rate monitoring
- Periodic blood tests to check kidney and liver function
- Awareness of potential interactions with new medications
- Maintaining a healthy lifestyle to complement medication effects
- Discussing any plans for pregnancy with your healthcare provider, as carvedilol may not be suitable during pregnancy
In conclusion, carvedilol stands as a vital medication in the treatment of various heart conditions, offering significant benefits for many patients. Its unique properties and versatility make it a valuable tool in cardiovascular care. As with any long-term medication, patients should work closely with their healthcare providers to ensure optimal use and monitoring of carvedilol therapy, maximizing its benefits while minimizing potential risks.
Carvedilol: a medicine used to treat high blood pressure and prevent angina, heart disease and stroke.
1. About carvedilol
Carvedilol is a beta blocker.
It’s used to treat high blood pressure (hypertension) and helps prevent:
- heart disease
- heart attacks
- strokes
It can also be given with other medicines to treat heart failure and to prevent chest pain caused by angina.
Carvedilol is only available on prescription. It comes as tablets.
2. Key facts
- Carvedilol slows down your heart rate and makes it easier for your heart to pump blood around your body.
- You’ll usually take carvedilol once or twice a day.
- It usually starts to work after about 1 hour. But it will take days or weeks for it to reach its full effect.
- Common side effects of carvedilol include headaches and feeling tired or dizzy.
- Do not stop taking carvedilol suddenly. This can make your condition worse, especially if you have heart disease.
3. Who can and cannot take carvedilol
Carvedilol can be taken by most adults. It can sometimes be prescribed by a specialist for children aged 2 years and over.
Carvedilol is not suitable for some people. Tell your doctor before starting the medicine if you have:
- ever had an allergic reaction to carvedilol or any other medicines
- lung disease or asthma
- heart failure that is getting worse
- have low blood pressure (hypotension) or a slow heart rate
- a liver problem
- serious circulation problems in your arms and legs, such as Raynaud’s
4.
How and when to take carvedilol
When you start taking carvedilol, your doctor may advise you to take your first dose just before you go to bed. This is because it can make you feel dizzy.
After the first dose, if you do not feel dizzy, you can take your medicine in the morning. If you do feel dizzy, it’s best to keep taking your medicine at bedtime.
It’s best to take carvedilol at the same time each day.
If you take it twice a day, you’ll usually have 1 dose in the morning and 1 dose in the evening. Leave 10 to 12 hours between doses if you can.
Swallow the tablets whole with a drink of water. Do not chew or crush them.
Carvedilol does not usually upset your stomach, so you can take it with or without food. However, if you are taking carvedilol for heart failure, it’s best to take the tablets with food. This will help reduce the risk of you feeling dizzy or faint when you stand up.
If you find tablets difficult to swallow, some strengths have a score line to help you break the tablet in half. Check the information leaflet that comes with your medicine to see if you can do this.
Dosage
Carvedilol tablets come in 4 different strengths – 3.125mg, 6.25mg, 12.5mg and 25mg.
How much you take depends on why you need carvedilol.
The usual starting dose to treat:
- high blood pressure is 12.5mg once a day for 2 days – this is increased to 25mg, taken once a day. If your blood pressure does not go down enough your doctor may increase your dose to up to 50mg a day. This can be taken as a single dose or split into 2 doses.
- heart failure is 3.125mg, taken twice a day for 2 weeks. Your doctor will then slowly increase the dose every 2 weeks up to a maximum of 25mg to 50mg (depending on your weight).
- angina is 12.5mg, taken twice a day for 2 days – this is increased to 25mg, taken twice a day.
If your child is prescribed carvedilol, the doctor will use their weight to work out the right dose.
What if I forget to take it?
If you miss a dose of carvedilol, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
The amount of carvedilol that can lead to an overdose varies from person to person.
Taking too much carvedilol can lower your blood pressure, slow your heart rate, and make it difficult to breathe.
Urgent advice: Contact 111 for advice now if:
- you take too much carvedilol
Call 111 or go to 111.nhs.uk
If you need advice for a child under the age of 5 years, call 111.
5. Side effects
Like all medicines, carvedilol can cause side effects in some people, but many people have no side effects or only minor ones.
Side effects usually improve as your body gets used to the medicine.
Common side effects
These common side effects may happen in more than 1 in 100 people. They’re usually mild and last a few days after starting the medicine or increasing your dose.
Talk to your doctor or pharmacist if these side effects bother you or do not go away:
- feeling dizzy
- headaches
- feeling tired
- feeling or being sick (nausea or vomiting)
- cold fingers or toes
Serious side effects
It happens rarely, but some people have serious side effects when taking carvedilol.
Tell a doctor straight away if you have:
- nose bleeds that last for more than 10 minutes, unexplained bruising, or you bruise more easily than usual – these can be signs of low numbers of platelets in your blood (thrombocytopenia)
- high temperature, sore throat, mouth sores, toothache, flu-like symptoms – these can be signs of a low number of white blood cells (leukopenia)
- shortness of breath with a cough that gets worse when you exercise (like walking up the stairs), swollen ankles or legs, chest pain, or an irregular heartbeat – these may be signs of other heart problems
- shortness of breath, wheezing and tightening of your chest – these can be signs of lung problems
- yellow skin or the whites of your eyes turn yellow – these can be signs of liver problems
Serious allergic reaction
In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to carvedilol.
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
- your throat feels tight or you’re struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of carvedilol. For a full list see the leaflet inside your medicines packet.
Information:
You can report any suspected side effect using the Yellow Card safety scheme.
Visit Yellow Card for further information.
6. How to cope with side effects of carvedilol
What to do about:
- feeling dizzy – as your body gets used to carvedilol this side effect should wear off. If carvedilol makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better. Do not drive or operate machinery until you feel OK again. Try to avoid alcohol as it’ll make you feel worse.
- headaches – make sure you rest and drink plenty of fluids. Ask your pharmacist to recommend a painkiller. Do not drink too much alcohol. Headaches usually go away after the first week of taking carvedilol. Talk to your doctor if the headaches last more than a week or are severe.
- feeling tired – do not drive, ride a bike, or use tools or machinery if you’re feeling tired. Do not drink any alcohol as this will make you feel more tired.
- feeling sick or being sick – stick to simple meals and do not eat rich or spicy food. It might help to take your carvedilol after a meal or snack. If you’re being sick, try drinking small, frequent sips of water to avoid dehydration.
- cold fingers or toes – put your hands or feet under warm running water, massage them, and wiggle your fingers and toes. Do not smoke or have drinks with caffeine, as this can make your blood vessels narrower and restrict your blood flow. It’s best not to wear tight watches or bracelets as well. Try wearing mittens (they’re warmer than gloves) and warm socks. Speak to your doctor if this side effect bothers you.
7. Pregnancy and breastfeeding
Carvedilol and pregnancy
Carvedilol is not usually recommended if you’re pregnant.
If you’re trying to get pregnant or you’re already pregnant, talk to your doctor about taking carvedilol. It may be possible to change to other medicines that are more suitable when you’re pregnant, such as labetalol or nifedipine.
Carvedilol and breastfeeding
If your doctor or health visitor says that your baby is healthy, it’s OK to take carvedilol while breastfeeding.
There is no information about whether carvedilol passes into breast milk, but it would only be expected to pass through in small amounts. It’s unlikely to cause any side effects in your baby.
If you notice that your baby isn’t feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your health visitor, midwife or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you’re:
- trying to get pregnant
- pregnant
- breastfeeding
Find out more about high blood pressure and pregnancy.
8. Cautions with other medicines
There are some medicines that can affect the way carvedilol works.
Tell your doctor if you’re taking:
- other medicines for high blood pressure – when taken together with carvedilol, they can sometimes lower your blood pressure too much
- other medicines that can lower your blood pressure – these include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or levodopa (for Parkinson’s disease)
- medicines for an irregular heartbeat such as amiodarone or flecainide
- medicines for asthma or chronic obstructive pulmonary disease (COPD)
- medicines for diabetes, particularly insulin – carvedilol may make it more difficult to recognise the warning signs of low blood sugar. Speak to your doctor if you have low blood sugar levels without getting any warning signs. You should check your blood sugar after exercise, and follow usual advice about checking it before driving, or operating machinery.
- medicines that treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
- medicines for allergies, such as ephedrine, noradrenaline or adrenaline
- non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, diclofenac and naproxen – these medicines may increase your blood pressure
Mixing carvedilol with herbal remedies and supplements
There’s very little information about taking herbal remedies and supplements with carvedilol. However, some herbal products, such as cod liver oil, hawthorn and garlic tablets may cause low blood pressure (hypotension).
Important:
Medicine safety
Tell your doctor or pharmacist if you’re taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about carvedilol
How does carvedilol work?
Carvedilol is a type of medicine called a beta blocker.
Like other beta blockers, carvedilol works by slowing down your heart rate and making it easier for your heart to pump blood around your body.
It also works like an alpha blocker to widen some of your blood vessels. This helps lower your blood pressure.
For angina, carvedilol works by improving the blood supply to your heart. Angina is chest pain that comes on when not enough blood gets to the muscles of the heart. It usually happens because the arteries to the heart become hardened and narrowed.
Carvedilol widens the arteries so more oxygen gets to the heart and chest pain is prevented. It also slows your heart down and makes it beat more effectively. This reduces the amount of oxygen needed by your heart muscle and prevents angina.
How long does it take to work?
Carvedilol usually starts to work after about 1 hour. But it will take days or weeks to reach its full effect.
You may not feel any different when you take carvedilol for high blood pressure, but this does not mean it’s not working. It’s important to keep taking your medicine.
How long will I take it for?
Usually, treatment with carvedilol is long term. It may be for the rest of your life.
Can I take carvedilol for a long time?
Most people take carvedilol for a long time with no problems. In fact, it works best when you take it long term.
What will happen if I stop taking it?
Talk to your doctor if you want to stop taking carvedilol. If you’re bothered by side effects, your doctor may be able to prescribe a different medicine instead.
How does it compare with other medicines for high blood pressure?
Carvedilol works as well as other beta blockers to reduce blood pressure, but it’s mainly used to prevent angina or heart failure because it also widens the blood vessels.
The main difference with carvedilol is that it can affect other parts of your body too, such as your lungs.
Other medicines used to lower blood pressure work in different ways to beta blockers. These include:
- ACE inhibitors such as ramipril and lisinopril
- angiotensin receptor blockers like losartan
- calcium channel blockers like amlodipine
- medicines that make you pee more (diuretics) like indapamide
The medicine your doctor prescribes first depends on your age and ethnicity. If you’re under 55 years old, you’ll usually be offered an ACE inhibitor or an angiotensin receptor blocker. If you’re 55 years old or over, or of African Caribbean or black African origin, you’ll usually be offered a calcium channel blocker.
If you are bothered by side effects, you may have to try a different blood pressure medicine. Many people need to take a combination.
How does it compare with other medicines for chest pain and angina?
There are lots of other medicines to prevent angina attacks.
They include:
- calcium channel blockers such as diltiazem and amlodipine
- nitrates like isosorbide mononitrate
- medicines such as ranolazine, nicorandil or ivabradine
If carvedilol does not work for you, or you cannot take carvedilol or other beta blockers because of side effects, you may be able to switch to another medicine.
Your doctor will be able to decide which medicine is best for you. Some people may need to take a combination of medicines to control their angina symptoms.
How does it compare with other medicines that treat heart failure?
Carvedilol is used with other medicines to treat heart failure and prevent complications, These can include ACE inhibitors (like ramipril and lisinopril) or angiotensin receptor blockers (like losartan).
Other beta blockers like bisoprolol and nebivolol can be used instead of carvedilol in a similar way.
Will I need to stop carvedilol before surgery?
Tell your doctor you’re taking carvedilol if you’re going to be put to sleep (using general anaesthetic) or have any kind of major operation.
Your doctor may advise you to stop taking carvedilol before surgery.
This is because carvedilol can lower your blood pressure too much when it’s combined with some general anaesthetics.
Can I drink alcohol?
Drinking alcohol can increase the blood pressure-lowering effect of carvedilol. This can make you feel dizzy or lightheaded.
During the first few days of taking carvedilol, or after an increase in your dose, it is best to stop drinking alcohol until you see how the medicine affects you.
If you find carvedilol makes you feel dizzy it’s best to stop drinking alcohol.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking carvedilol.
Eating a healthy, balanced diet can help your heart condition.
Will it affect my contraception?
Carvedilol will not stop your contraception working.
But some types of combined hormonal methods of contraception, such as the combined pill and contraceptive patch, are not usually recommended for women with high blood pressure.
Talk to your doctor if you’re taking a combined hormonal contraceptive.
If carvedilol makes you vomit, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.
Read more about what to do if you’re on the pill and you’re being sick.
Will it affect my fertility?
There’s no clear evidence to suggest that taking carvedilol will reduce fertility in either men or women.
If you’re trying for a baby or having problems getting pregnant while on carvedilol, speak to your doctor.
Will it affect my sex life?
Some people on carvedilol say their sex drive goes down and some men say they cannot get an erection.
There’s not enough evidence to say that carvedilol causes this.
If you’re having problems with your sex life, talk to your doctor.
Do I need to avoid playing sports?
You do not need to stop playing sports if you take carvedilol. But it’s a good idea not to push yourself too much.
Regular exercise is good for you because it lowers blood pressure by keeping your heart and blood vessels in good condition.
However, in some sports carvedilol may not be allowed if you’re competing at a very high level.
Can I drive or ride a bike?
Carvedilol can make you feel tired or dizzy, especially when you first start taking it or after increasing your dose.
If this happens to you, do not drive a car, ride a bike, or use tools or machinery until you feel OK again.
Can lifestyle changes help heart problems?
If you have heart problems, you can boost the health of your heart by making some lifestyle changes.
It’s a good idea to:
- quit smoking – not smoking will bring down your blood pressure and relieve heart failure symptoms.
- cut down on alcohol – drinking too much alcohol raises blood pressure over time and makes heart failure worse. Drinking alcohol while you’re taking carvedilol can make you feel dizzy or lightheaded.
- exercise – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Even walking every day will help.
- eat well and lower the salt in your diet – aim to eat plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. Eating too much salt is the biggest cause of high blood pressure – the more salt you eat, the higher your blood pressure will be.
- deal with stress – when you’re anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Finding ways to cope with stress will help to keep your blood pressure down.
Carvedilol Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing
Warnings:
Do not stop taking this medication without consulting your doctor. Some conditions may become worse when you suddenly stop this drug. Some people who have suddenly stopped taking similar drugs have had chest pain, heart attack, and irregular heartbeat. If your doctor decides you should no longer use this drug, your doctor may direct you to gradually decrease your dose over 1 to 2 weeks.
When gradually stopping this medication, it is recommended that you temporarily limit physical activity to decrease strain on the heart. Get medical help right away if you develop chest pain/tightness/pressure, chest pain spreading to the jaw/neck/arm, unusual sweating, trouble breathing, or fast/irregular heartbeat.
Warnings:
Do not stop taking this medication without consulting your doctor. Some conditions may become worse when you suddenly stop this drug. Some people who have suddenly stopped taking similar drugs have had chest pain, heart attack, and irregular heartbeat. If your doctor decides you should no longer use this drug, your doctor may direct you to gradually decrease your dose over 1 to 2 weeks.
When gradually stopping this medication, it is recommended that you temporarily limit physical activity to decrease strain on the heart. Get medical help right away if you develop chest pain/tightness/pressure, chest pain spreading to the jaw/neck/arm, unusual sweating, trouble breathing, or fast/irregular heartbeat.
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Uses
Carvedilol is used to treat high blood pressure and heart failure. It is also used after a heart attack to improve the chance of survival if your heart is not pumping well. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.This drug works by blocking the action of certain natural substances in your body, such as epinephrine, on the heart and blood vessels. This effect lowers your heart rate, blood pressure, and strain on your heart. Carvedilol belongs to a class of drugs known as alpha and beta blockers.
How to use Carvedilol
See also Warning section.
Read the Patient Information Leaflet if available from your pharmacist before you start taking carvedilol and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth with food as directed by your doctor, usually twice daily.
The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.
Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.
For the treatment of high blood pressure, it may take 1 to 2 weeks before you get the full benefit of this drug. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.
Tell your doctor if your condition does not improve or if it worsens (for example, your blood pressure readings remain high or increase, or you have worsening symptoms of heart failure like increased shortness of breath).
Side Effects
See also Warning and Precautions sections.
Dizziness, lightheadedness, drowsiness, diarrhea, impotence, or tiredness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. The risk of dizziness is highest within 1 hour after you take your dose. Taking this medication with food and starting treatment with a low dose and slowly increasing your dose as directed by your doctor help to reduce the risk of dizziness.
This drug may reduce blood flow to your hands and feet, causing them to feel cold. Smoking may worsen this effect. Dress warmly and avoid tobacco use.
Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: very slow heartbeat, severe dizziness, fainting, unusual weakness, signs of kidney problems (such as change in the amount of urine), numbness/tingling of the hands/feet, blue fingers/toes, easy bruising/bleeding, mental/mood changes (such as confusion, depression), seizures.
Although this medication may be used to treat heart failure, some people may rarely develop new or worsening symptoms of heart failure, especially at the start of carvedilol treatment. Tell your doctor right away if you develop any of these serious side effects: shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Precautions
Before taking carvedilol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: certain types of heartbeat/heart rhythm problems (such as slow/irregular heartbeat, sick sinus syndrome, second- or third-degree atrioventricular block), breathing problems (such as asthma, chronic bronchitis, emphysema), severe heart failure requiring hospitalization, liver disease, kidney disease, blood circulation problems (such as Raynaud’s disease, peripheral vascular disease), serious allergic reactions including those needing treatment with epinephrine, overactive thyroid disease (hyperthyroidism), a certain type of tumor (pheochromocytoma), other heart problems (such as Prinzmetal’s variant angina), a certain muscle disease (myasthenia gravis), certain eye problems (cataracts, glaucoma).
This drug may make you dizzy or drowsy or cause you to faint. This is most likely to occur within 1 hour after taking your dose, especially when you start carvedilol treatment or any time your doctor increases your dose. During these periods, avoid driving and doing hazardous tasks. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
People who wear contact lenses may have dry eyes while taking this medication.
Before having surgery (including cataract/glaucoma eye surgery), tell your doctor or dentist if you are taking or have ever taken this medication, and about all the other products you use (including prescription drugs, nonprescription drugs, and herbal products).
This product may prevent the fast/pounding heartbeat you would usually feel when your blood sugar level falls too low (hypoglycemia). The risk is higher if you have diabetes, or are vomiting, fasting, or not eating regularly. Other symptoms of low blood sugar level, such as dizziness and sweating, are not affected by this drug.
If you have diabetes, this product may make it harder to control your blood sugar levels. Check your blood sugar levels regularly as directed by your doctor. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet.
Children may be at greater risk for low blood sugar (hypoglycemia) while using this drug, especially if they are vomiting or not eating regularly. To help prevent low blood sugar, make sure children eat regularly. If your child cannot eat regularly, is vomiting, or has symptoms of low blood sugar (such as sweating, shaking), tell the doctor right away.
Older adults may be more sensitive to the side effects of this drug, especially dizziness and lightheadedness.
Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using carvedilol. Carvedilol may harm an unborn baby. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.
It is unknown if carvedilol passes into breast milk. However, it is unlikely to pass into breast milk in large amounts. There is a low risk that it may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
One product that may interact with this drug is: fingolimod.
Some products have ingredients that could raise your heart rate or blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).
Does Carvedilol interact with other drugs you are taking?
Enter your medication into the WebMD interaction checker
Overdose
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: very slow heartbeat, severe dizziness, fainting, slow/shallow breathing, seizures.
Do not share this medication with others.
Lifestyle changes that may help this medication work better include exercising, stopping smoking, and eating a low-cholesterol/low-fat diet. Consult your doctor for more details.
Have your blood pressure and pulse (heart rate) checked regularly while taking this medication. Learn how to monitor your own blood pressure and pulse at home, and share the results with your doctor.
Lab and/or medical tests (such as kidney/liver function) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Images
carvedilol 12.5 mg tablet
Color: whiteShape: roundImprint: ZC41
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: ovalImprint: 257
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: ovalImprint: logo 55
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: roundImprint: ZC42
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: roundImprint: Z 1
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: ovalImprint: E 01
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 12.5 mg tablet
Color: whiteShape: ovalImprint: 256
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: ovalImprint: 255
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: ovalImprint: 254
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 12.5 mg tablet
Color: whiteShape: ovalImprint: E 03
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: ovalImprint: 244
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: ovalImprint: 242
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: roundImprint: G
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: roundImprint: ZC40
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 12.5 mg tablet
Color: whiteShape: oblongImprint: G 164
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: roundImprint: G41 25
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: roundImprint: G 41
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: ovalImprint: E 02
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: roundImprint: R 255
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: ovalImprint: E 04
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: ellipticalImprint: 93 7296
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: ellipticalImprint: TV 7296
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: ellipticalImprint: 93 135
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: ellipticalImprint: TV 135
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: ellipticalImprint: 93 51
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: ellipticalImprint: TV 51
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: ovalImprint: SZ 117
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 12.5 mg tablet
Color: whiteShape: ovalImprint: SZ 116
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: ovalImprint: SZ 62
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: whiteShape: ovalImprint: SZ 61
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 12.5 mg tablet
Color: whiteShape: roundImprint: M C33
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: ovalImprint: 247
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 12.5 mg tablet
Color: whiteShape: ovalImprint: 245
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: ovalImprint: logo and 56
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 12.5 mg tablet
Color: whiteShape: ellipticalImprint: TV 7295
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 12.5 mg tablet
Color: whiteShape: ellipticalImprint: 93 7295
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 25 mg tablet
Color: whiteShape: roundImprint: M C34
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 6.25 mg tablet
Color: whiteShape: roundImprint: M C32
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
carvedilol 3.125 mg tablet
Color: blueShape: roundImprint: M C31
This medicine is a white, round, film-coated, tablet imprinted with “ZC41”.
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Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.
Carvedilol – instructions for use, doses, side effects, reviews of the drug: tablets, 25 mg
Description of the drug Carvedilol (tablets, 12.5 mg) based on official instructions, approved by the manufacturer in 2005
Approval date: 01.07.2 005
Contents
- Active substance
- ATX
- Pharmacological group
- Nosological classification (ICD-10)
- Composition and form of release
- pharmachologic effect
- pharmachologic effect
- Pharmacodynamics
- Pharmacokinetics
- Indications
- Contraindications
- Use during pregnancy and lactation
- Dosage and administration
- Side effects
- Interaction
- Overdose
- Precautionary measures
- special instructions
- Manufacturer
- Storage conditions
- Best before date
- Order in Moscow pharmacies
Active ingredient
Carvedilol* (Carvedilol*)
ATX
C07AG02 Carvedilol
Pharmacological group
Alpha and beta blockers
Nosological classification (ICD-10)
ICD-10 code list
Composition and form of release
Table Tags | 1 tab. |
carvedilol | 12.5 mg |
25 mg | |
excipients: milk sugar; sucrose; polyvidone K25; crospovidone; methylcellulose; croscarmellose sodium |
in a blister pack of 10 pcs., in a carton box of 3 packs.
Pharmacological action
Pharmacological action –
vasodilator , antianginal , antiarrhythmic .
Blocks alpha 1 -, beta 1 – and beta 2 -adrenergic receptors. It does not have its own sympathomimetic activity, it has membrane-stabilizing properties. It has an antioxidant effect, eliminating free oxygen radicals.
Blocks alpha 1 -, beta 1 – and beta 2 -adrenergic receptors. It does not have its own sympathomimetic activity, it has membrane-stabilizing properties. It has an antioxidant effect, eliminating free oxygen radicals.
Pharmacodynamics
Reduces OPSS, reduces pre- and afterload on the heart. It does not have a pronounced effect on lipid metabolism and the content of potassium, sodium and magnesium in blood plasma.
Pharmacokinetics
Rapidly and almost completely absorbed from the gastrointestinal tract. Binds to plasma proteins by 98-99%. Bioavailability is about 25% due to the high degree of metabolism in the liver. Metabolites have beta-blocking properties. Food slows absorption but does not affect bioavailability. Plasma concentration is proportional to the dose taken. With max in plasma is achieved after 1 hour. T 1/2 – 6-10 hours. Excreted mainly with bile.
In elderly patients, plasma concentrations are approximately 50% higher than in younger patients. In case of impaired liver function, bioavailability can increase up to 80%. Passes through the placental barrier, excreted in breast milk.
Indications
Arterial hypertension (monotherapy or in combination with other antihypertensive drugs), stable angina pectoris.
Contraindications
Hypersensitivity, chronic obstructive pulmonary disease, severe liver failure, severe bradycardia, sick sinus syndrome, II and III degree AV block (except in patients with a pacemaker), decompensated heart failure, pulmonary hypertension or cardiogenic shock, arterial hypotension, pregnancy, breast-feeding, age up to 18 years (safety and efficacy in persons under 18 years of age have not been established).
Use during pregnancy and lactation
Contraindicated. At the time of treatment should stop breastfeeding.
Dosage and administration
Information for healthcare professionals only.
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By mouth, after meals, with a little liquid. The dose is selected individually.
Hypertension: The recommended dose for the first 7-14 days is 12.5 mg/day in the morning after breakfast or divided into 2 doses of 6.25 mg, then 25 mg/day once in the morning or divided into 2 doses of 12. 5 mg. After 14 days, the dose may be increased again.
Stable angina: Initial dose is 12.5 mg twice daily, after 7-14 days under medical supervision the dose may be increased to 25 mg twice daily. After 14 days, with insufficient efficacy and good tolerability of the drug, the dose can be further increased. The total daily dose should not exceed 100 mg (50 mg 2 times a day), over the age of 70 – 50 mg / day (25 mg 2 times a day).
If the next dose is missed, the drug should be taken as soon as possible, however, if the time for the next dose is approaching, then take only it, without doubling it. If it is necessary to cancel the drug, the dose should be reduced gradually over 1-2 weeks.
Side effects
From the side of the nervous system and sensory organs: headache, dizziness, syncope, muscle weakness (more often at the beginning of treatment), sleep disturbances, depression, paresthesia, decreased secretion of lacrimal fluid.
From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): bradycardia, AV blockade, orthostatic hypotension, rarely – “intermittent” claudication, impaired peripheral circulation, progression of heart failure, thrombocytopenia, leukopenia.
From the respiratory system: sneezing, nasal congestion, bronchospasm, shortness of breath (in predisposed patients).
From the digestive tract: dry mouth, nausea, vomiting, abdominal pain, diarrhea or constipation, increased liver transaminase activity.
From the urinary system: severe renal dysfunction, edema.
From the side of the skin: exacerbation of psoriatic rashes.
Allergic reactions: exanthema, urticaria, itching, rash.
Other: influenza-like syndrome, pain in the extremities, weight gain.
Interactions
Information for healthcare professionals only.
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Enhances the effect of hypoglycemic agents, increases the concentration of digoxin in the blood. Some antiarrhythmic drugs, anesthetics, antihypertensives, antianginal drugs, other beta-blockers (including in the form of eye drops), MAO inhibitors, sympatholytics (reserpine), cardiac glycosides may enhance the effect. Cimetidine increases the concentration of carvedilol in the blood; rifampicin, phenobarbital – reduce. Simultaneous use with ergot alkaloids impairs peripheral circulation. Incompatible with the / in the introduction of verapamil and diltiazem (possibly pronounced slowing of the heart rate and a pronounced decrease in blood pressure).
Overdose
Symptoms: pronounced decrease in blood pressure, bradycardia, impaired respiratory function (including bronchospasm), heart failure, cardiogenic shock, cardiac arrest.
Treatment: gastric lavage, administration of adrenergic agonists; symptomatic therapy.
Precautions
Use with caution in bronchospastic syndrome, chronic bronchitis, pulmonary emphysema, Prinzmetal’s angina (may worsen), diabetes mellitus or hypoglycemia (regular monitoring of blood glucose levels is necessary), hyperthyroidism, peripheral vascular disease (may worsen), pheochromocytoma (prescription of beta-adrenergic blockers is possible only after prior therapy with alpha-blockers), depression, myasthenia gravis, psoriasis, renal failure, severe metabolic acidosis, in patients using contact lenses.
At the beginning of treatment and with increasing doses, orthostatic hypotension, dizziness, syncope may occur (especially in elderly patients with heart failure or while using other antihypertensive drugs or diuretics). It is recommended to monitor renal function in patients with renal insufficiency, coronary artery disease, diffuse peripheral vascular disease, heart failure (with a deterioration in renal function, drug withdrawal is necessary). It is possible to reduce the sensitivity of allergic tests. Before extensive surgical interventions, a gradual withdrawal of the drug is recommended. If concomitant therapy with carvedilol and clonidine is discontinued, treatment with carvedilol should be discontinued initially, and clonidine should be discontinued only a few days later.
It is not recommended to drink alcoholic beverages during the treatment period.
Special instructions
Do not stop taking the drug or change its dosage without first consulting a doctor. If treatment is interrupted for 2 weeks or more, treatment should be resumed with the lowest doses. If there is no therapeutic effect or if the condition worsens, you should consult your doctor.
Should not be used during work by drivers of vehicles and people whose profession is associated with increased concentration of attention.
Producer
Makiz-Pharma, Russia.
Storage conditions
In a dry, dark place, at a temperature not exceeding 25 °C.
Keep out of reach of children.
Expiry date
3 years.
Do not use after the expiry date which is stated on the package.
Date of update: 06/07/2023
The information provided on the prices of drugs is not an offer to sell or buy goods.
The information is intended solely for comparing prices in stationary pharmacies operating in
in accordance with Article 55 of the Federal Law “On the Circulation of Medicines” dated April 12, 2010 No. 61-FZ.
Statins and aldosterone antagonists in patients with acute coronary syndrome and postinfarction patients
A.E. Bagriy, Doctor of Medical Sciences, Professor, Donetsk National Medical University. M. Gorkogo
Standard approaches to the treatment of patients with acute coronary syndrome (ACS), as well as those who have had myocardial infarction (MI), are described in sufficient detail in the relevant domestic and international recommendations. Despite this, the routine practice of managing this significant contingent of patients (and about 50 thousand cases of myocardial infarction are registered annually in Ukraine) very often does not correspond to world approaches. In this regard, it is important to once again recall the basic principles of therapeutic approaches in relation to the discussed categories of patients.
General view of the treatment of patients with ACS
Table 1 shows only some of the important components of diagnostic and therapeutic care for such patients; more detailed information can be found in the relevant regulatory documents. Let’s stop only on some moments. Consideration of the details of choosing an invasive (including emergency and early invasive) or non-invasive strategy for the treatment of these patients is beyond the scope of this article. Here it is only necessary to point out that in modern recommendations in patients with various types of ACS (both in MI with ST segment elevation (ST MI “↑”), and in ACS without ST segment elevation (ST ACS “-“) in the presence of a high level of cardiovascular risk, absolute priority is given to invasive reperfusion approaches – percutaneous coronary intervention (PCI) with stenting.
Among the platelet P2Y12 receptor inhibitors (the current name for this group as a whole), clopidogrel is under strong pressure from new drugs, such as non-thienopyridine member of the triazolopyrimidine subgroup, ticagrelor.
Among drugs that are used to improve prognosis (especially for secondary prevention), preference is usually given to those for which there is evidence from large randomized controlled trials (RCTs) about their positive effect on cardiovascular prognosis. For example, in ACS, β-blockers with an appropriate evidence base, such as metoprolol, carvedilol, propranolol, should be prescribed; the same applies to blockers of the renin-angiotensin system, statins and other classes of drugs.
General view on the treatment of postinfarction patients. Secondary prevention
Table 2 presents the main approaches to the management of patients after myocardial infarction. There are also only a few comments here. All recommendations emphasize the high effectiveness of lifestyle changes in improving cardiovascular prognosis.
The post-infarction patient typically requires at least (more often more than) four classes of long-term “heart protection” drugs. These are a statin, an antithrombotic drug (or two drugs), an ACE inhibitor (often an aldosterone antagonist), a β-blocker (nowadays ivabradine is often added to it in such patients). Nitrates, calcium channel blockers, trimetazidine can also be used as additional approaches to control angina pectoris.
Place of statins
Table 3 presents data on the use of statins in the treatment of individuals with ACS and patients who have had myocardial infarction. Statins are one of the most popular groups of drugs in cardiology; they should be used almost everywhere in patients with increased cardiovascular risk, which is regulated by the relevant domestic and international recommendations. Let us briefly present the data concerning one of the most authoritative representatives of the statin group – atorvastatin.
The SATURN RCT (Nicholls S.J. et al., 2011) in 1039 patients with chronic ischemic heart disease was recently published comparing the effect of the highest doses of potent statins, atorvastatin 80 mg/day and rosuvastatin 40 mg/day, on the severity of coronary atherosclerosis, assessed using a paired int coronary ultrasound examination (before and after 104 weeks of treatment). Both statins caused a clear regression of atherosclerotic plaque (both absolute and relative volumes), there were no differences between the drugs in the primary endpoint, rosuvastatin demonstrated a slightly more pronounced effect in the secondary endpoint. Plaque regression was observed in most patients – 60-70%. Drugs were well tolerated:
- an increase in the level of transaminases 3 times higher than ULN was observed in 0.7-2.0% of patients;
- increase in creatine kinase 5 times higher than ULN – in 0.3-0.7%;
- , taking into account the data presented above, it is important to note that the degree of increase in the level of glycosylated hemoglobin was only 0.05-0.09%.
It is well known that atorvastatin has the most solid evidence base for use in patients with various types of ACS – RCT MIRACL, PROVE-IT. In just 30 days of use (additional analysis PROVE-IT, Cannon C. et al., 2004), atorvastatin reduced the risk of the primary endpoint in ACS by 33%, p=0.04. In ACS and after it, it is desirable to use high doses of the drug (usually 80 mg / day), and these doses must be prescribed at the stage of ACS, regardless of the initial level of LDL-C (even if the target levels of this indicator have already been achieved, which is convincingly shown in the work of K. H. Lee et al., 2011).
It is interesting to point out the data of a rigorous analysis carried out in 2011 by F. Colvicchi et al., who studied the results of replacing the intensive statin regimen in postinfarction patients with a moderate one (which is often practiced both abroad and in our country by general practitioners and outpatient cardiologists). The study included 1321 patients after ACS, all patients were discharged from the hospital while taking 80 mg/day of atorvastatin. Within 12 months, in 42% of them, the statin regimen was changed (the dose was reduced and / or the original drug was replaced with a generic one). The reason for the decrease in the intensity of statin therapy was either side effects or concerns about their development (in a detailed analysis of all these cases, no significant side effects were noted in any patient). Importantly, the change in treatment regimen was accompanied by a marked increase in cardiovascular risk (compared to patients who continued the original atorvastatin 80 mg/day). So, if this change occurred within 30 days from the onset of ACS, then the risk increased by 5.6 times, 90 days – 4.9 times, 180 days – 3.9 times, 270 days – 3.1 times, 360 days – 2.7 times. Summing up, the authors point out the desirability of maintaining intensive statin therapy with a reputable drug in patients after ACS in the absence of contraindications.
Based on evidence from several convincing RCTs, high-dose statins (particularly atorvastatin 80 mg/day, and several studies used an unapproved loading dose of 160 mg on day 1) are indicated before and after coronary revascularization procedures (both PCI with stenting – primary or elective, and coronary artery bypass grafting) and after these procedures to improve cardiovascular vascular prognosis. Impressive data are presented in 2012 by M. Antoniades et al., who noted significant and very rapid positive effects of high doses of atorvastatin on the superoxide anion (O 2 -) and peroxynitrite (ONOO-). Discussing the presented results, U. Laufs, O. Adam (2012) point out that these previously little known acute beneficial effects of statins may be related to their effects on endothelial NO synthase (eNOS) and NAD(P)H oxidase.
The action of atorvastatin goes beyond cardio and vasoprotection. In 2011, an additional analysis of the well-known RCT ASCOT-LLA was published, during which the use of atorvastatin at a dose of 10 mg significantly improved the prognosis in patients with arterial hypertension without severe hyperlipidemia. After 11 years from the start of the study (and 6 years after its completion), it was noted that as a result of therapy, not only did the therapy maintain a steady improvement in cardiovascular prognosis in the atorvastatin group, but there was also a significant reduction in total mortality by 14% and non-cardiovascular mortality by 15%, p = 0.0001. The reduction in non-cardiovascular mortality with atorvastatin was predominantly associated with a reduction in infectious and respiratory deaths.