6 Carvedilol Interactions You Should Know About

If you have heart failure or another heart condition, you might be taking carvedilol (Coreg). It’s a beta blocker that can help reduce the strain on your heart. It does this by slowing down your heart rate and relaxing your blood vessels. But sometimes these effects can be intensified due to interactions with other medications.

Some carvedilol interactions are more common than others. Interactions with other heart medications often top the list. In these cases, close monitoring and dosage changes may be required. But some combinations should be avoided altogether. 

Let’s discuss a few common ones you might encounter.

1. Heart rhythm medications

Heart rhythm medications (antiarrhythmics) are used to treat an irregular heart beat. They work to regulate your heart rate. Carvedilol also affects how fast your heart beats. Combining these medications may make your heart beat too slowly (called bradycardia). 

Some heart rhythm medications also change how carvedilol is broken down (metabolized) by the body. This can cause higher carvedilol levels, which can lower your heart rate even further. Examples of these include amiodarone (Pacerone), propafenone, and quinidine.

It’s not unusual for people with heart failure to also have heart rhythm problems. So, it’s possible that you might be taking carvedilol with one of these medications. In this case, your healthcare provider may adjust your medication dosages and monitor you more closely.

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Let them know if you develop signs and symptoms of bradycardia. These can include feeling lightheaded, heart palpitations, and/or chest pain.

2. Digoxin

Digoxin (Lanoxin) is used to treat heart failure and certain heart rhythm problems. But it’s not used as often as other medications due to its serious side effects and interactions. It also requires regular monitoring to ensure your blood levels stay within a safe range.

When taken together, digoxin and carvedilol can cause a slow heart rate. What’s more, carvedilol can increase digoxin levels in your blood. This can lead to more digoxin side effects, such as nausea, vomiting, and diarrhea.

Your healthcare provider may recommend this combination for you. But they’ll want to monitor your digoxin levels closely and adjust your dosage as needed. Let them know if you develop worse or new side effects, since this could mean your digoxin levels are too high.

3. Certain antidepressant medications

Antidepressants are used to treat mental health conditions like depression and anxiety. Some antidepressants prevent carvedilol from being broken down, resulting in higher levels. Examples of these antidepressants include fluoxetine (Prozac) and paroxetine (Paxil).

Monoamine oxidase inhibitors (MAOIs) are an older class of antidepressants. Some are also used to manage symptoms of Parkinson’s disease. Examples include selegiline (Zelapar, Emsam) and phenelzine (Nardil). MAOIs can interact with many foods, supplements, and medications, including carvedilol. 

Both of these interactions can cause a slow heart rate and low blood pressure (hypotension). Hypotension can make you feel lightheaded and dizzy. You may feel like you’re going to pass out.

Your healthcare provider may need to adjust your carvedilol dosage and monitor you for side effects during treatment. They may also recommend a different antidepressant that’s less likely to interact.

4. Other blood pressure medications

Often, other blood pressure medications are combined with carvedilol to treat heart conditions. Sometimes these combinations can lower your heart rate and blood pressure too much.

For example, verapamil and diltiazem are calcium channel blockers used for high blood pressure and chest pain. Verapamil is also approved to treat certain heart rhythm problems. Your healthcare provider may avoid combining them with carvedilol. If not, they’ll want to monitor your heart and blood pressure more closely.

Clonidine is also used to treat high blood pressure. Taking clonidine and carvedilol together isn’t as common. This combination can cause a slow heart rate and low blood pressure. Plus, stopping either one abruptly can be dangerous. This can cause a spike in your blood pressure. Your healthcare provider can advise on how to stop taking these medications safely.

5. Rifampin

Rifampin is an antibiotic approved to treat tuberculosis. It’s also used to prevent meningococcal disease transmission. Rifampin is well-known for interacting with medications broken down by the liver. And carvedilol is one of them.

When taken together, rifampin can lower carvedilol levels in the body by as much as 70%. If you need to take this combination, your healthcare provider may adjust your carvedilol dosage. But you shouldn’t change the way you take your medication on your own. 

6. Cyclosporine

Cyclosporine (Sandimmune) is an immunosuppressant medication that helps prevent your body from rejecting an organ transplant. Cyclosporine modified (Gengraf, Neoral) is also used to treat autoimmune conditions, such as rheumatoid arthritis and psoriasis. 

While it seems to vary by person, carvedilol may increase cyclosporine levels in your body. This can potentially lead to kidney and liver problems. Your healthcare provider should closely monitor cyclosporine levels when you’re starting carvedilol. They may recommend a dosage adjustment for cyclosporine. 

When should I contact my healthcare provider about a carvedilol interaction?

If you’re concerned about a potential medication interaction with carvedilol, contact your healthcare provider or pharmacist.

Sometimes, medications can still be used together — even if there’s an interaction between them. Your healthcare provider will decide when this is a safe and appropriate choice. Have your current medication list handy so they can review it for interactions. Make sure your list includes all prescription and over-the-counter medications you take, including vitamins and supplements.

You should also contact them if you experience any signs or symptoms of a slow heart rate or low blood pressure. These include dizziness, fatigue, and chest pain. Watch for these any time you start a new medication or your dosages are changed.

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Written by:

Zuri C. Hawkins-Jarrett, PharmD, MPH, BCPS

Zuri Hawkins-Jarrett graduated with her doctorate in pharmacy from The University of Georgia College of Pharmacy. She completed her residency training with Piedmont Columbus Regional in ambulatory care.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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References

Bryant Ranch Prepack. (2022). Carvedilol [package insert].