Carvedilol
carvedilolum
Also known as: Coreg CR · Eucardic · BM-14190 · carvedilolum · Cardilol · Cardiol · Carloc · Carvil · Carvipress · Coritensil · Coropres · Dilatrend · Dilbloc · Dimitone · Divelol · Hybridil · Kredex · Querto
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Heart failure (adjunctive therapy) | ¼-½ of a 3.125 mg tablet PO twice daily | PO | twice daily | — | 🌎 NA |
| Early/mild heart failure or later stages of CHF | 0.2 mg/kg PO twice daily initially with slow titration upwards towards a dose of 0.8 mg/kg twice daily | PO | twice daily | — | 🌎 NA |
| Heart failure (target plasma concentration) | 0.5 mg/kg PO twice daily | PO | twice daily | — | 🌎 NA |
| Dilated cardiomyopathy | 0.3 mg/kg PO q12h | PO | q12h | 3 months | 🌎 NA |
| Chronic heart failure / Dilated Cardiomyopathy (DCM) | Start at 0.05-0.1 mg/kg, gradually increase at 2-week intervals to target dose of 0.3-0.4 mg/kg | PO | q12h | Long-term | 🌍 EU |
| ACVIM stage B2 degenerative mitral valve disease | 0.3 mg/kg, increased at intervals up to 1.1 mg/kg | PO | q12h | Long-term | 🌍 EU |
- Heart failure (adjunctive therapy): Usual starting dose. Start at the low end of the dosing range and gradually titrate upward carefully watching to avoid negative inotropic effects.
- Early/mild heart failure or later stages of CHF: Beta blockers are best employed in dogs that are minimally symptomatic. Many dogs with CHF will not tolerate this upward titration.
- Heart failure (target plasma concentration): Should result in beta-blockade, but maximum beta-blockade may require doses of >0.7-0.9 mg/kg. Because of bioavailability variations, plasma monitoring, clinical trials and uptitration protocols may be beneficial.
- Dilated cardiomyopathy: Did not produce any significant improvements in neurohormonal activation, heart size, or owner-perceived quality of life. Doses >0.3 mg/kg q12h are likely to be required to effect changes in ventricular remodeling and function.
- Chronic heart failure / Dilated Cardiomyopathy (DCM): Increase dose only if tolerated.
- ACVIM stage B2 degenerative mitral valve disease: For cardiac remodelling with no signs of cardiac failure.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Carvedilol is a unique, third-generation non-selective beta-blocker with alpha-1 adrenergic blocking properties. In veterinary medicine, it is primarily investigated as an adjunctive treatment for canine dilated cardiomyopathy (DCM) and chronic heart failure.
- Dual Action: Unlike traditional beta-blockers (like atenolol), carvedilol provides additional vasodilatory effects, reducing cardiac afterload.
- Controversial Use: Its use in veterinary cardiology remains controversial. While it has proven mortality benefits in human heart failure, studies in dogs have shown mixed results regarding its efficacy in improving neurohormonal activation or ventricular remodeling at standard doses.
- Clinical Pearl: Carvedilol is a profound negative inotrope. It can precipitate acute decompensation in patients with advanced or highly symptomatic heart failure. It requires extremely cautious, slow up-titration and is best initiated in minimally symptomatic patients.
Mechanism of action
Carvedilol exerts its cardiovascular effects through multiple mechanisms:
- Non-selective Beta-Adrenergic Blockade (β1 and β2): Heart failure leads to chronic sympathetic nervous system (SNS) activation → tachycardia, renin-angiotensin-aldosterone system (RAAS) activation, beta-receptor downregulation, and myocyte necrosis. Carvedilol blocks these receptors → reverses/diminishes SNS toxicity, reduces heart rate, and decreases myocardial oxygen demand.
- Selective Alpha-1 Adrenergic Blockade: Blocks peripheral α1-receptors → vasodilation → reduces systemic vascular resistance and cardiac afterload.
- Antioxidant Properties: Carvedilol and its metabolites act as potent scavengers of reactive oxygen species (ROS) and inhibit lipid peroxidation, protecting the myocardium from oxidative stress.
- Antidysrhythmic Effects: Secondary to its beta-blocking and membrane-stabilizing properties.
Safety & warnings
Contraindications
- Class IV decompensated heart failure
- Bronchial asthma
- 2nd or 3rd degree AV block
- Sick sinus syndrome (unless artificially paced)
- Severe bradycardia
- Cardiogenic shock
- Hypersensitivity to the drug
Adverse effects
- Inappetence
- Lassitude (lethargy/fatigue)
- Hypotension
- Decompensation of heart failure (if titrated too rapidly)
- Bronchospasm (reported in humans)
- Mild hepatocellular injury (rare)
Precautions
Black Box Warning Equivalent: Too rapid beta blockade can cause decompensation in patients with heart failure; cautious dosage titration is mandatory.
- Hepatic Insufficiency: Because the drug is extensively metabolized in the liver, patients with hepatic insufficiency should receive the drug with caution.
- Pregnancy/Nursing: FDA Category C. Increased post-implantation loss seen in animal studies. Unknown if it enters canine milk, but does enter rat milk. Use with caution in nursing patients.
Drug interactions
Use with carvedilol may cause additive effects
May rarely cause hemodynamic compromise
May decrease metabolism and increase AUC of carvedilol
Carvedilol may potentiate the cardiovascular effects of clonidine
Carvedilol may increase cyclosporine levels
Can increase digoxin plasma concentrations by approximately 15%
May increase R(+)carvedilol concentrations and increase alpha-1 blocking effects (vasodilation)
Carvedilol may enhance the blood glucose lowering effects of insulin or other antidiabetic agents
Can decrease carvedilol plasma concentrations by as much as 70%
Can cause increased bradycardia and hypotension in patients taking carvedilol
Enhanced hypotensive effect and myocardial depression
Enhanced hypotensive effect
Enhanced hypotensive effect
Enhanced hypotensive effect
Enhanced hypotensive effect
Increased risk of bradycardia, severe hypotension, heart failure, and AV block
May antagonize the hypotensive effect of carvedilol
May enhance the hypoglycaemic effect of insulin and mask signs of hypoglycaemia
Carvedilol increases plasma concentration of ciclosporin
Contraindicated; risk of severe hypertension and bradycardia
Monitoring
- Clinical efficacy (improvement in heart failure signs)
- Adverse effects (lethargy, inappetence, hypotension, worsening heart failure)
- Plasma drug levels (Target: 50-100 nanograms/mL)
Pharmacokinetics
Half-life
Absorption
In dogs, bioavailability after oral dosing averages about 23%, but is highly variable (ranging from 3-10% in some individuals). In humans, it is rapidly and extensively absorbed but has a high first-pass effect, resulting in ~30% bioavailability.
Distribution
In dogs, volume of distribution averages about 1.4 L/kg. In humans, it is extensively bound to plasma proteins (98%).
Metabolism
Extensively metabolized in the liver. In dogs, hydroxylation of the carbazolyl ring and glucuronidation are the predominant processes (at least 15 metabolites identified). In humans, CYP2D6 and CYP2C9 are the primary P450 isoenzymes responsible.
Elimination
Metabolites are primarily excreted via the bile and feces.
Overdose
The acute oral LD50 in healthy rats and mice is greater than 8 grams/kg.
Clinical Signs of Overdose:
- Severe hypotension
- Cardiac insufficiency
- Bradycardia
- Cardiogenic shock
- Death due to cardiac arrest
Treatment:
- Gut emptying protocols should be considered if ingestion was recent.
- Bradycardia: Treat with atropine.
- Cardiovascular Support: Support function with glucagon and sympathomimetics (e.g., dobutamine, epinephrine).
- Contact an animal poison control center for specific information.
Available products
Formulations
- Oral tablets
- Extended-release oral capsules
- Compounded oral suspension
Human-labeled
- Carvedilol Oral Tablets: 3.125 mg, 6.25 mg, 12.5 mg, & 25 mg (Coreg, generic)
- Carvedilol Extended-Release Oral Capsules: 10 mg, 20 mg, 40 mg & 80 mg as phosphate (Coreg CR)
Regulatory status
POM (Prescription Only Medicine)
POM (Prescription Only Medicine)
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Tablets and extended-release capsules should be stored below 30°C (86°F), protected from moisture, and dispensed in tight, light-resistant containers. Compounded oral suspensions (2 mg/mL or 10 mg/mL in simple syrup) should be stored in amber bottles at temperatures not exceeding 25°C and protected from light for up to 90 days. Shake well before administering.
Client information
Important Information for Pet Owners
- Strict Dosing: Give this medication exactly as your veterinarian prescribes. Do not stop the medication abruptly without the approval and guidance of your veterinarian, as this can cause a dangerous rebound effect on the heart.
- Watch for Worsening Signs: Contact your veterinarian immediately if your pet's condition worsens while receiving this medication (e.g., increased coughing, difficulty breathing).
- Monitor for Side Effects: Call your vet if your pet shows signs of reduced appetite, severe fatigue or listlessness, dizziness, or unsteadiness (which may indicate low blood pressure).
- Administration: This medication is best given with food to help with absorption and reduce the risk of sudden blood pressure drops.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.