Carvedilol Side Effects and Management

Introduction to Carvedilol Side Effects

The most common side effects of carvedilol include dizziness, fatigue, hypotension, bradycardia, and gastrointestinal disturbances, with most adverse events occurring early in therapy and often resolving with continued treatment 1
Dizziness or lightheadedness occurs at a rate 5.5% higher than placebo 1
Hypotension occurs in 8.6% of patients in clinical trials 1
Bradycardia occurs in 9.3% of patients in clinical trials 1
Syncope occurs in 1-2% of patients 1
Fatigue is a common side effect, especially during initiation 2
Headache occurs in 8.2% of patients in clinical trials 1
Nausea occurs in 8.6% of patients in clinical trials 1
Vomiting occurs in 6.6% of patients in clinical trials 1
Weight gain is reported in heart failure trials 1
Dyspnea is reported in heart failure patients 1
Worsening renal function occurs in 6.6% of patients in clinical trials 1
Hyperglycemia is reported in clinical trials 1

Monitor for increases in weight and worsening signs of heart failure 2
Augment diuretic dose if weight increases 2
Fluid retention is not generally a reason for permanent withdrawal of treatment 2
Side effects may resolve spontaneously within several weeks 2
Side effects can be managed by reducing the dose of carvedilol or accompanying diuretic 2
Consider discontinuation if accompanied by evidence of peripheral hypoperfusion 2
Bradycardia is generally asymptomatic and requires no treatment 2, 3
If bradycardia is accompanied by dizziness or lightheadedness, decrease the dose 2, 3
Consider possible drug interactions with other medications that can cause bradycardia 2, 3
Hypotension is usually asymptomatic but may produce dizziness, lightheadedness, or blurred vision 2, 3
Strategies to minimize hypotension include administering beta-blocker and ACE inhibitor at different times of day, temporary reduction in ACE inhibitor dose if needed, and consider decreasing diuretic dose in volume-depleted patients 2, 3
Decrease or discontinue carvedilol if accompanied by evidence of hypoperfusion 2, 3

Never stop carvedilol suddenly as this can lead to clinical deterioration and should be avoided 3
If discontinuation is necessary, gradually taper the dose over time 3