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 5 mg tablet | ৳ 5.00 | ৳ 50.00 |
Description
Overview of the medicine
Xelcard 5 mg Tablet contains Carvedilol, a beta-blocker and alpha-1 blocker used to treat essential hypertension, chronic stable angina, and symptomatic mild to severe chronic heart failure.
Uses & Indications
Dosage
Adults
Hypertension: Initial dose 6.25 mg twice daily, may be increased to 12.5 mg then 25 mg twice daily. Chronic Heart Failure: Initial dose 3.125 mg twice daily for 2 weeks, then increased to 6.25 mg twice daily, and gradually increased at intervals of at least 2 weeks, up to a maximum of 25 mg twice daily (for patients <85 kg) or 50 mg twice daily (for patients >85 kg). The 5 mg tablet may be used as part of a titration regimen or for maintenance as directed by a physician.
Elderly
No specific dosage adjustment is required, but initiation and titration should be performed with caution, especially in patients with impaired renal or hepatic function.
Renal_impairment
No dosage adjustment is usually needed for mild to moderate renal impairment. However, carvedilol should be used with caution and careful monitoring in patients with severe renal impairment.
How to Take
Take orally with food to minimize the risk of orthostatic hypotension and to increase absorption. Do not crush or chew the tablet; swallow it whole.
Mechanism of Action
Carvedilol is a non-selective beta-adrenergic blocking agent with alpha-1 blocking activity. It reduces heart rate, myocardial contractility, and causes peripheral vasodilation, leading to a reduction in blood pressure and cardiac workload.
Pharmacokinetics
Onset
Antihypertensive effect usually within 1 hour; peak effect within 1-2 hours.
Excretion
Primarily via biliary excretion into feces; minor renal excretion.
Half life
Approximately 7-10 hours.
Absorption
Rapidly and extensively absorbed from the gastrointestinal tract, but undergoes significant first-pass metabolism. Absolute bioavailability is approximately 25-35%.
Metabolism
Primarily hepatic, extensively metabolized by oxidation and glucuronidation, mainly by CYP2D6 and CYP2C9 enzymes.
Side Effects
Contraindications
- Hypersensitivity to carvedilol or any component of the formulation
- Severe unstable heart failure (NYHA Class IV) requiring intravenous inotropic therapy
- Bronchial asthma or related bronchospastic conditions (e.g., COPD with a bronchospastic component)
- 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 (heart rate <50 bpm)
- Severe hepatic impairment
Drug Interactions
Digoxin
May increase digoxin levels.
Clonidine
Potentiation of blood pressure and heart rate lowering effects. If co-administered, discontinue carvedilol several days before clonidine withdrawal.
Rifampicin
May decrease carvedilol plasma concentrations.
Insulin/Oral Hypoglycemics
May enhance the blood glucose lowering effect and mask symptoms of hypoglycemia.
Fluoxetine, Paroxetine, Quinidine
May increase carvedilol plasma concentrations by inhibiting CYP2D6.
Calcium channel blockers (e.g., Verapamil, Diltiazem)
Potentiation of AV conduction disturbances and/or ventricular dysfunction.
Storage
Store in a cool, dry place below 30°C. Protect from moisture and light. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, bradycardia, cardiac insufficiency, cardiogenic shock, and cardiac arrest. Management is supportive, including atropine for bradycardia, glucagon for hypotension, and intravenous fluids.
Pregnancy & Lactation
Pregnancy Category C: Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Lactation: Carvedilol is excreted in breast milk. Breastfeeding is not recommended while taking this medicine.
Side Effects
Contraindications
- Hypersensitivity to carvedilol or any component of the formulation
- Severe unstable heart failure (NYHA Class IV) requiring intravenous inotropic therapy
- Bronchial asthma or related bronchospastic conditions (e.g., COPD with a bronchospastic component)
- 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 (heart rate <50 bpm)
- Severe hepatic impairment
Drug Interactions
Digoxin
May increase digoxin levels.
Clonidine
Potentiation of blood pressure and heart rate lowering effects. If co-administered, discontinue carvedilol several days before clonidine withdrawal.
Rifampicin
May decrease carvedilol plasma concentrations.
Insulin/Oral Hypoglycemics
May enhance the blood glucose lowering effect and mask symptoms of hypoglycemia.
Fluoxetine, Paroxetine, Quinidine
May increase carvedilol plasma concentrations by inhibiting CYP2D6.
Calcium channel blockers (e.g., Verapamil, Diltiazem)
Potentiation of AV conduction disturbances and/or ventricular dysfunction.
Storage
Store in a cool, dry place below 30°C. Protect from moisture and light. Keep out of reach of children.
Overdose
Symptoms of overdose include severe hypotension, bradycardia, cardiac insufficiency, cardiogenic shock, and cardiac arrest. Management is supportive, including atropine for bradycardia, glucagon for hypotension, and intravenous fluids.
Pregnancy & Lactation
Pregnancy Category C: Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Lactation: Carvedilol is excreted in breast milk. Breastfeeding is not recommended while taking this medicine.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24 to 36 months from the date of manufacture.
Availability
Pharmacies, Hospitals
Approval Status
Approved by major regulatory bodies (e.g., FDA, DGDA)
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Carvedilol has been extensively evaluated in numerous clinical trials for its efficacy and safety in treating hypertension, angina, and chronic heart failure, including landmark studies like the COPERNICUS trial for heart failure.
Lab Monitoring
- Blood pressure (regularly)
- Heart rate (regularly)
- Renal function (especially in heart failure patients or those with existing renal impairment)
- Liver function tests (periodically, especially if signs of liver dysfunction occur)
- Blood glucose (in diabetic patients, as carvedilol can mask hypoglycemia symptoms)
Doctor Notes
- Emphasize the importance of slow dose titration, especially in heart failure patients, to optimize benefits and minimize adverse effects.
- Caution patients against abrupt discontinuation due to the risk of rebound angina, hypertension, or myocardial infarction.
- Monitor for signs of worsening heart failure and adjust diuretic therapy as needed.
Patient Guidelines
- Do not stop taking this medicine suddenly without consulting your doctor, as it can worsen your condition.
- Always take this medicine with food.
- Report any symptoms of dizziness, slow heartbeat, breathing difficulties, or swelling of the ankles to your doctor immediately.
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 resume your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
This medicine may cause dizziness, fatigue, or lightheadedness, especially at the start of treatment or after dose increases. Avoid driving or operating heavy machinery until you know how this medicine affects you.
Lifestyle Advice
- Maintain a healthy diet low in sodium and saturated fats, and rich in fruits and vegetables.
- Engage in regular physical activity as advised by your doctor to support cardiovascular health.
- Avoid smoking and limit alcohol consumption, as these can negatively impact blood pressure and heart health.
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