Hypertension: An initial dose of 12.5 mg once daily by mouth, increased after 2 days to 25 mg once daily. Alternatively, an initial dose of 6.25 mg is given twice daily, increased after 1-2 weeks to 12.5 mg twice daily. The dose may be increased further if necessary, at intervals of at least 2 weeks to 50 mg once daily or in divided doses. A dose of 12.5 mg once daily may be adequate for elderly patients.
Angina Pectoris: An initial dose of 12.5 mg is given twice daily by mouth, increased after 2 days to 25 mg twice daily.
Heart Failure: The initial dose is 3.125 mg twice daily by mouth. It should be taken with food to reduce the risk of hypotension. If tolerated, the dose should be doubled after 2 weeks to 6.25 mg twice daily and then increased gradually at intervals of not less than 2 weeks, to the maximum dose tolerated by the patient; this should not exceed 25 mg twice daily in patients weighing <85 kg or 50 mg twice daily in patients weighing >85 kg. Patients should be monitored for 2-3 hrs after initiation and after each dose increase.
Carvedilol should be administered to patients with left ventricular ejection fraction <45% and cardiac rate >65 times/min during a break and stable patients having fundamental treatment of angina at least before 4 weeks [in case of no change to New York Heart Association (NYHA) class or basic treatment and no occurrence of hospitalization by aggravation of symptoms].
In case of every up-titration, physician should certainly check whether aggravation of cardiac failure and side effects by vasodilation (eg, descending blood pressure and dizziness) to patients, regular medical examination (eg, renal function, weigh, blood pressure and cardiac rate, etc) should be instituted. In congestive heart failure patients, worsening cardiac failure or fluid retention may occur during up-titration of carvedilol. If such symptoms occur, diuretic should be increased and the carvedilol dose should not be advanced until clinical stability resumes. Occasionally, it may be necessary to lower the carvedilol dose or temporarily discontinue it. When given again after discontinuing administration over 2 weeks, it should start from initial dose (3.125 mg twice a day).