Xelcard
Generic Name
Carvedilol
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| xelcard 10 mg tablet | ৳ 6.50 | ৳ 65.00 |
Description
Overview of the medicine
Xelcard 10 mg Tablet contains Carvedilol, a non-selective beta-blocker with alpha-blocking activity, used to treat high blood pressure, chronic stable angina, and symptomatic chronic heart failure.
Uses & Indications
Dosage
Adults
Hypertension: Initially 12.5 mg once daily, increasing to 25 mg once daily after 2 days. Heart Failure: Initially 3.125 mg twice daily for two weeks, gradually increasing to maximum 25 mg twice daily or 50 mg once daily.
Elderly
Similar to adult dosage, but titration should be done carefully, starting with lower doses.
Renal_impairment
No dosage adjustment usually required for mild to moderate renal impairment. Use with caution in severe impairment.
How to Take
Take orally with food to slow the rate of absorption and reduce the risk of orthostatic hypotension. Do not crush or chew.
Mechanism of Action
Carvedilol blocks beta-1, beta-2, and alpha-1 adrenergic receptors. Beta-blockade reduces heart rate and myocardial contractility, leading to decreased cardiac output and blood pressure. Alpha-1 blockade causes vasodilation, further reducing peripheral vascular resistance.
Pharmacokinetics
Onset
Within 1 hour for blood pressure reduction, peak effect typically 1-2 hours.
Excretion
Primarily excreted via bile into feces, with minor renal excretion.
Half life
Approximately 7-10 hours.
Absorption
Rapidly absorbed after oral administration, bioavailability is about 25-35% due to extensive first-pass metabolism.
Metabolism
Extensively metabolized in the liver, primarily by CYP2D6 and CYP2C9, to active and inactive metabolites.
Side Effects
Contraindications
- Bronchial asthma or related bronchospastic conditions
- Second or third-degree AV block (unless a permanent pacemaker is in place)
- Sick sinus syndrome (unless a permanent pacemaker is in place)
- Cardiogenic shock
- Severe bradycardia
- Decompensated heart failure requiring intravenous inotropic therapy
- Severe hepatic impairment
Drug Interactions
Digoxin
Increased digoxin levels and additive bradycardia.
Cimetidine
Increased carvedilol bioavailability.
Rifampicin
Decreased carvedilol plasma levels.
MAO inhibitors
Potentiation of hypotensive effects and bradycardia.
Antidiabetic agents
May mask symptoms of hypoglycemia.
Calcium channel blockers (e.g., Verapamil, Diltiazem)
Increased risk of AV conduction disturbances and heart failure.
Storage
Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe hypotension, bradycardia, heart failure, cardiogenic shock, and cardiac arrest. Management involves symptomatic and supportive treatment, including atropine for bradycardia, vasopressors for hypotension, and diuretics/digitalis for heart failure.
Pregnancy & Lactation
Pregnancy Category C. Carvedilol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is unknown whether carvedilol is excreted in human milk; use with caution in nursing mothers.
Side Effects
Contraindications
- Bronchial asthma or related bronchospastic conditions
- Second or third-degree AV block (unless a permanent pacemaker is in place)
- Sick sinus syndrome (unless a permanent pacemaker is in place)
- Cardiogenic shock
- Severe bradycardia
- Decompensated heart failure requiring intravenous inotropic therapy
- Severe hepatic impairment
Drug Interactions
Digoxin
Increased digoxin levels and additive bradycardia.
Cimetidine
Increased carvedilol bioavailability.
Rifampicin
Decreased carvedilol plasma levels.
MAO inhibitors
Potentiation of hypotensive effects and bradycardia.
Antidiabetic agents
May mask symptoms of hypoglycemia.
Calcium channel blockers (e.g., Verapamil, Diltiazem)
Increased risk of AV conduction disturbances and heart failure.
Storage
Store in a cool, dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms include severe hypotension, bradycardia, heart failure, cardiogenic shock, and cardiac arrest. Management involves symptomatic and supportive treatment, including atropine for bradycardia, vasopressors for hypotension, and diuretics/digitalis for heart failure.
Pregnancy & Lactation
Pregnancy Category C. Carvedilol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is unknown whether carvedilol is excreted in human milk; use with caution in nursing mothers.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date
Availability
Pharmacies, hospitals, clinics
Approval Status
Approved by major regulatory bodies (e.g., FDA, DGDA)
Patent Status
Generic available (original patent expired)
WHO Essential Medicine
YesClinical Trials
Numerous clinical trials have established the efficacy and safety of carvedilol in hypertension, angina, and heart failure, including studies like the US Carvedilol Heart Failure Study and CAPRICORN trial.
Lab Monitoring
- Blood pressure monitoring
- Heart rate monitoring
- Renal function (creatinine, BUN)
- Liver function tests (ALT, AST)
- Blood glucose in diabetic patients
Doctor Notes
- Always titrate dose slowly, especially in heart failure patients.
- Counsel patients on orthostatic hypotension, particularly with first dose or dose increases.
- Avoid abrupt discontinuation; taper dose over 1-2 weeks.
- Monitor for signs of worsening heart failure or bradycardia.
Patient Guidelines
- Take with food to minimize dizziness and lightheadedness.
- Do not stop taking abruptly; consult your doctor for gradual dose reduction.
- Monitor your blood pressure and heart rate regularly as advised by your doctor.
- Inform your doctor about all other medications you are taking.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
May cause dizziness or fatigue, especially at the start of treatment or dose increases. Patients should be advised to exercise caution when driving or operating machinery until they know how Xelcard affects them.
Lifestyle Advice
- Adopt a healthy diet low in sodium and saturated fats.
- Engage in regular physical activity as tolerated.
- Avoid smoking and excessive alcohol consumption.
- Manage stress effectively.
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