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CARDIOVASCULAR SYSTEM › BETA BLOCKING AGENTS › BETA BLOCKING AGENTS, OTHER COMBINATIONS › Beta blocking agents, other combinations
carvedilol and ivabradine
C07FX06
Forms & Strengths
- Carvedilol 25mg/Ivabradine 5mg tablet
- Carvedilol 50mg/Ivabradine 5mg tablet
- Carvedilol 25mg/Ivabradine 7.5mg tablet
Adult Dosing
- Initial dose: 25mg carvedilol with 5mg ivabradine once daily
- Titrate every 2 weeks as needed and tolerated, max dose 50mg carvedilol with 7.5mg ivabradine twice daily
Pediatric Dosing
- Not established for pediatric patients
- Carvedilol monotherapy dosing in pediatric heart failure is weight-based, but combination with ivabradine lacking
Indications
- Treatment of heart failure with reduced ejection fraction (HFrEF) in adult patients
- Treatment of symptomatic stable angina pectoris in adult patients
Mechanism of Action
- Carvedilol is a beta-blocker, alpha-1 blocker, and antioxidant
- Ivabradine is an I(f) channel inhibitor reducing heart rate
Contraindications
- Severe hypotension
- Bradycardia
- Sick sinus syndrome (unless a pacemaker is in place)
- Severe hepatic impairment
- Pacemaker dependence
Adverse Reactions
- Most common: bradycardia, hypotension, dizziness, headache
- Other: worsening heart failure, atrioventricular block, visual disturbances
Drug Interactions
- Verapamil or diltiazem may increase risk of AV block
- Negative inotropic agents may worsen heart failure
- CYP2D6 inhibitors may increase carvedilol levels
- Strong CYP3A4 inhibitors may increase ivabradine levels
Curated Content: Needs Vetting Before Put to Clinical Use