Carvedilol Contraindication in Asthma

Introduction to Carvedilol and Asthma

• Carvedilol is a non-selective beta-blocker that blocks beta-1, beta-2, AND alpha-1 receptors, which can cause severe and sometimes fatal bronchoconstriction in people with asthma 1, 2, 3

Clinical Evidence and Guidelines

• The American Heart Association recommends that in patients with chronic obstructive lung disease or a history of asthma, beta-blockers are not contraindicated in the absence of active bronchospasm, but beta-1 selective agents are strongly preferred and should be initiated at low doses 4
• The European Society of Cardiology notes that non-selective beta-blockers, such as carvedilol, should not be prescribed for patients with asthma, while cardioselective beta-blockers may be used cautiously when strongly indicated 2, 3
• The American College of Cardiology recommends that if beta-blocker therapy is absolutely necessary in a patient with lung disease, use cardioselective agents such as bisoprolol, metoprolol succinate, or nebivolol, and start with low doses and monitor closely for bronchospasm 1, 4, 5

Safer Alternatives for Patients Requiring Beta-Blockade

• Cardioselective agents, such as bisoprolol, metoprolol succinate, or nebivolol, are recommended in cases of bronchospastic airway disease requiring a beta-blocker, and should be started at low doses and monitored closely for bronchospasm 3, 4, 5
• The European Heart Journal recommends avoiding carvedilol specifically in cases of asthma, and using beta-1 selective agents instead 2