The package insert of the medicine Coreg

the package insert of the drug Coreg.

what For?

congestive heart Failure mild or moderate (class II or III NYHA) ischemic or cardiomiopática, along with digitalis, diuretics and ACE inhibitor, to reduce the progression of the disease as evidenced by cardiovascular death, hospitalization for cardiovascular or the need to adjust other medications for heart failure. Coregup4 may be used in patients unable to tolerate an ACE inhibitor. Coregup4 can be used in patients who are receiving treatment with digitalis, hydralazine, or nitrates. Hypertension: Coregup4 is also indicated for the control of essential hypertension. Can be used alone or in combination with other agents anti-hypertensive medications, especially thiazide diuretics.

Contraindications

When should I not use?

In patients with decompensated heart failure, class IV NYHA requiring therapy inotropic intravenous, bronchial asthma, or in conditions broncoespásticas, AV block of second or third degree, syndrome, disease, sick sinus syndrome (unless a pacemaker is in place), cardiogenic shock, or bradycardia severe. The use of Coreg in patients with hepatic insufficiency, clinically evident is not recommended. Coregup4 is contraindicated in patients with hypersensitivity to the drug.

Dosage

How to use?

congestive heart Failure: the dose should be individualized and carefully monitored by a doctor during the phase of increase of the same. Before beginning treatment with Coreg, the dosage of digitalis, diuretics and ACE inhibitors (if used) should be stabilized. The recommended initial dose for Coregup4 is 3,125 mg twice a day for two weeks. If this dose is tolerated, may be increased to 6.25 mg twice a day. The dose should then be doubled every two weeks up to the maximum level tolerated by the patient. At the beginning of each new dose, patients should be observed for one hour to determine the signs of vertigo or disorientation. The recommended maximum dose is 25 mg twice daily in patients weighing less than 85 kg and 50 mg twice daily in patients weighing more than 85 kg. Coregup4 should be taken with food to slow the speed of absorption and reduce the incidence of effects ortostáticos. Before each dose increase the patient should be observed in the office and evaluated for symptoms of worsening heart failure, vasodilation (dizziness, disorientation, hypotension, symptomatic) or bradycardia, in order to determine the tolerance to Coreg. The worsening transient heart failure can be treated with increased doses of diuretics although occasionally it is necessary to reduce the dose of Coregup4 or descontinuá it temporarily. The symptoms of vasodilation often respond to a reduction in the dose of diuretics or ACE inhibitors. If these changes do not alleviate the symptoms, the dose of Coregup4 can be reduced. The dose of Coregup4 can not be increased until symptoms of worsening heart failure or vasodilation have stabilized. The difficulty start to increase the dose should not prevent later attempts to administer Coreg. If the patients with congestive heart failure to experience bradycardia (heart rate below 55 beats/minute), the dose of Coregup4 should be reduced. Hypertension: the dose should be individualized. The recommended starting dose of Coregup4 is 6.25 mg twice a day. If this dose is tolerated, using the systolic blood pressure in standing position, measured about 1 hour after dosing as a guide, the dose can be maintained for 7 to 14 days, and then increased to 12.5 mg two times a day, if necessary, based on the blood pressure minimum, again using the systolic pressure in standing position one hour after dosing as a guide to determine the tolerance. This dose should also be maintained for 7 to 14 days and can then be adjusted to 25 mg twice daily if tolerated and needed. The effect of anti-hypertensive total Coregup4 is observed in 7 to 14 days. The total daily dose should not exceed 50 mg. Coregup4 should be taken with food to slow the speed of absorption and reduce the incidence of effects ortostáticos. One can expect that the addition of a diuretic to Coreg, or Coregup4 a diuretic produces additive effects and exaggerate the component standing of the action of Coreg. Coreg should not be administered to patients with severe hepatic insufficiency. – Overdose: overdose can cause severe hypotension, bradycardia, heart failure, cardiogenic shock, and heart attack. Breathing problems, broncospasmos, vomiting, lapses of consciousness and attacks widespread, may also occur. The patient should be placed in the lying position and, when necessary, kept under observation and treated under conditions of intensive care. Gastric lavage or êmese pharmacologically induced can be used shortly after ingestion. The following agents may be administered: for bradycardia, excessive: atropine, 2 mg IV; to promote cardiovascular function: glucagon, 5 to 10 mg IV rapidly over 30 seconds, followed by a continuous infusion of 5 mg/hour; sympathomimetics (dobutamine, isoprenaline, adrenaline) at doses according to body weight and effect. If the peripheral vasodilatation prevail, it may be necessary to administer adrenaline or noradrenaline with continuous monitoring of circulatory conditions. For bradycardia, resistant to therapy, a pacemaker must be instituted. For bronchospasm, beta-sympathomimetics (in aerosol or IV) or aminophylline IV should be administered. In the case of seizures, the injection slow IV diazepam or clonazepam is recommended. In case of poisoning severe, with symptoms of shock, treatment with antidotes can be continued for a sufficiently long period of time, compatible with the half-life of 7 to 10 hours of carvedilol.

Side Effects

What are the evils that can cause me?

The following adverse reactions were reported more frequently in patients with congestive heart failure: peripheral oedema, allergy, sudden death, malaise, hypovolaemia. Cardiovascular: fluid overload, postural hypotension. Central and peripheral nervous system: hipestesia, vertigo. Gastrointestinal: melena, periodontitis. System liver and biliary: ALT increased, AST increased. Metabolic and nutritional: hyperuricemia, hypoglycemia, hyponatremia, alkaline phosphatase increased, glicosuria. Platelet, bleeding and clotting: prothrombin decreased, purpura. Psychiatric: somnolence. Reproductive, male: impotence. The urinary system: kidney function abnormal, albuminúria. Hypertension: in general, Coregup4 was well tolerated in doses up to 50 mg a day. Most of the reported adverse reactions during treatment with Coregup4 was severity mild to moderate. The overall incidence of adverse reactions increased with increased dose of Coreg. For adverse reactions to individual, this can be seen for dizziness, which increased in frequency from 2% to 5% when the total daily dose increased by 6.25 mg to 50 mg. Adverse events the following have been reported as possibly or probably related to Coregup4 in patients with hypertension or congestive heart failure: cardiovascular: peripheral ischemia, tachycardia. Central and peripheral nervous system: hipocinesia. Gastrointestinal: bilirrubinemia, liver enzymes increased. General: chest pain subesternal, edema. Psychiatric: nervousness, sleep disorders, depression aggravated concentration impaired thinking abnormally, paroníria, emotional instability. Respiratory system: asthma. Reproductive, male: libido decreased. Skin and appendages: pruritus, rash erythematosus, rash maculopapular, rash psoriasiform reaction photosensitivity. Special senses: tinnitus in the ear. The urinary system: frequency of urination. The autonomic nervous system: dry mouth, increased sweating. Metabolic and nutritional: hypokalemia, diabetes mellitus, and hypertriglyceridemia. Hematologic: anemia, leukopenia. The following events are potentially important: AV block complete, bundle branch block, ischemia, infarction, disorder cerebrovascular, convulsions, migraine, neuralgia, paresis, reaction anafilactóide, alopecia, exfoliative dermatitis, amnesia, bleeding of the gi-tract, bronchospasm, pulmonary edema, reduction of hearing, alcalose respiratory, nitrogen uréico of the blood (BUN) increased, high density lipoprotein (HDL) reduced, pancytopenia, and atypical lymphocytes.