What are the side effects of carvedilol in older adults?

In this article:

• Why age matters
• Common side effects
• When side effects start
• How long they last
• Long-term side effects
• Interactions
• Monitoring
• Bottom line

In this article

• Why age matters
• Common side effects
• When side effects start
• How long they last
• Long-term side effects
• Interactions
• Monitoring
• Bottom line

Carvedilol (brand name Coreg) is a beta blocker commonly prescribed to treat high blood pressure (hypertension) and other types of heart conditions. It helps the heart work more efficiently by slowing down your heart rate and relaxing blood vessels, improving circulation, and lowering blood pressure. 

Because more than 70% of adults over the age of 60 have hypertension, carvedilol is often prescribed to older adults. But aging bodies process medications less efficiently, and that can increase the risk of side effects. Here’s what to know about how carvedilol affects older adults and what symptoms to watch for. 

Why age matters with medication

As the body ages, the kidneys and liver, which metabolize most medications, become less efficient and process medications differently. Older adults become more sensitive to medications and may experience side effects or longer-lasting effects, even from medications and dosages they once tolerated well.

There are a few reasons why seniors are more affected by medications. As you age, your metabolism slows down, which alters how quickly a prescription is absorbed or eliminated from your body. It may also cause weight gain or loss, which also affects how drugs are stored and circulated. The organs responsible for breaking down drugs, like your kidneys and liver, may also begin working less efficiently. Alterations in your brain or nervous system may heighten your reaction to certain drugs, especially those affecting mood, balance, or alertness. Finally, older adults are commonly on more medications, increasing their risk for drug interactions that trigger side effects.

Common side effects of carvedilol 

Carvedilol helps control blood pressure, lower heart rate, and improve overall heart function, says Shivesh Kumar, MD, director of Reliant Physicians in Nevada. Like most beta blockers, it can cause side effects in any age group, but older adults may be more vulnerable due to other health conditions or medication use. Common side effects include:

• Dizziness
• Lightheadedness
• Fatigue
• Weakness
• Low blood pressure (hypotension)
• Slow heart rate (bradycardia) or irregular heartbeat

Certain preexisting conditions can heighten sensitivity to carvedilol’s effects, including heart failure, cardiovascular disease, kidney disease, and diabetes, according to Sarah Bonza, MD, a primary care provider based in Columbus, Ohio. Drug interactions with other medications can also increase a person’s risk for side effects. For example, people taking antidepressants and medications that lower blood pressure or heart rate, like digoxin and verapamil, may be more likely to experience hypotension and bradycardia, says Dr. Bonza. 

Finally, taking carvedilol can exacerbate the symptoms of certain medical conditions, especially in older adults. Dr. Kumar says it can raise your blood sugar levels if you have uncontrolled diabetes (even if you’re on insulin or other blood sugar-controlling medications), and may increase edema or swelling in people with peripheral vascular disease, a condition that causes reduced blood flow in the legs, arms, and other extremities.

Serious side effects of carvedilol 

In some people, carvedilol can cause serious or potentially life-threatening adverse effects, such as:

• Extremely slow heart rate
• Fluid in the lungs
• Angina (chest pain) 
• Heart attack, heart failure, or worsening of existing heart disease symptoms
• Low blood cell counts
• Bronchospasm in people with asthma

If you experience shortness of breath, trouble breathing, or swelling of the face, seek emergency medical attention as these could be signs of a severe allergic reaction.

How soon do carvedilol side effects start?

Carvedilol starts working quickly to slow down your heart rate and lower your blood pressure. That means side effects can start quickly, too. 

“There’s what we call the first dose effect, wherein we are expecting sudden drops in blood pressure or dizziness whenever a person stands up [as early as 1 to 2 days after beginning carvedilol],” says Dr. Bonza, noting that this is more common if your starting dose is higher than normal. 

If you’re concerned, Dr. Bonza suggests talking to your healthcare provider. Taking your carvedilol tablet with food or starting at a lower dose and slowly increasing to a higher one can reduce these early symptoms. When starting carvedilol, avoid changing positions too quickly. After lying down, sit up and wait about 15 seconds before standing. When you stand, hold onto a nearby surface for another 15 seconds to allow your blood pressure to adjust and reduce dizziness or risk of falling.

How long do carvedilol side effects last?

Most of the common side effects of carvedilol are temporary, says Dr. Kumar, including fatigue, dizziness, and hypotension. It may take some time to find the right maintenance dose for you, he adds. Once you do, these side effects will generally resolve within 2 weeks.  

What are the long-term side effects of carvedilol?

Long-term side effects of carvedilol are rare, per Dr. Kumar, but they include:

• High blood sugar
• Worsened kidney function
• Slow heart rate
• Erectile dysfunction  

Most people taking carvedilol won’t have long-term side effects. Less than 10% of people on carvedilol stop taking their medication because of symptoms like hypotension and slow heart rate. Side effects like worsened kidney function occur in less than 2% of people. Some people taking carvedilol experience erectile dysfunction (ED), but experts aren’t sure if the medication is the only cause because high blood pressure itself can trigger ED. In one small study, about 13.5% of men reported ED while taking carvedilol.

In general, however, older adults are more susceptible to long-term side effects. According to Dr. Bonza, adults over age 60 who are frail, have conditions like heart failure, cardiovascular disease, kidney disease, or diabetes, or who take medications that interact with carvedilol, have a higher rate of side effects. Carvedilol may not be the best choice for seniors who need a beta blocker but have coexisting conditions or take medications that increase the drug’s side effects. 

Carvedilol interactions

Some foods and drugs have known carvedilol interactions, increasing your risk for side effects or serious illness.

• Foods: Taking carvedilol with certain foods may affect how the medication works or how it makes you feel. Avoid grapefruit and caffeine, which can make the drug less effective; bananas, which may increase your risk of elevated potassium levels; and alcohol, which can increase your blood pressure and cause dizziness.
• Antidepressants: Some antidepressants make it harder for your liver to break down carvedilol, allowing blood levels of the drug to become too high. More common antidepressants that could interact with carvedilol include Prozac, Paxil, Wellbutrin, and Cymbalta.
• Diabetes drugs: As Dr. Kumar noted, carvedilol can affect your blood sugar levels, so taking it with diabetes medications like insulin and metformin may make it harder to ensure your blood sugar is at a healthy maintenance level.
• Blood pressure medications: Because carvedilol lowers your blood pressure, taking more than one type of blood pressure medication increases your risk for extremely low blood pressure. For example, use caution when taking calcium channel blockers like verapamil and diltiazem with carvedilol.
• Other heart medications: Medications used to treat heart arrhythmias, like digoxin and amiodarone, may slow your heart rate down too much when used in combination with carvedilol, as the effects of each medication may be additive

Monitoring and management: A proactive approach to carvedilol use

Older adults are often managing multiple medical conditions and keeping track of many different medications, which can be a serious burden logistically, financially, and emotionally. This can get even more complex when medications interact with one another, or a medication to treat one condition exacerbates a different condition.

To make it easier on yourself, be sure to have an open, honest line of communication with the healthcare provider prescribing you carvedilol. 

• Always discuss every medication, supplement, and over-the-counter drug you take with your provider and pharmacist so they can look for potential interactions. This information can also help them find the right dose of carvedilol for you and minimize your side effects, says Dr. Kumar. 
• Be sure to share any changes to your medical history when they occur, including new diagnoses, medications, or symptoms.
• Ask if there are additional things you can do at home (like exercising more or eating less of certain foods) that might complement your treatment or safely improve your symptoms.
• Never stop taking carvedilol suddenly; Dr. Kumar says it should be tapered slowly over the course of 1 to 2 weeks, under the supervision of your healthcare provider. 
• Ask for assistance managing your medications if you are struggling. There are ways to streamline your regimen so it’s easier to take the right doses of the right medications at the right times, but you don’t have to do that alone—your healthcare provider and pharmacist can help.

Bottom line: Is carvedilol safe for older adults?

In general, carvedilol is a safe way to manage hypertension and lower the risks associated with heart disease, but it’s not right for every adult over 60. Because of their age, seniors have a higher chance of experiencing side effects like dizziness, fatigue, low blood pressure, and slow heart rate while taking carvedilol. These risks are even higher if you have certain medical conditions or take other medications that can interact with carvedilol.

For most people taking carvedilol, side effects are temporary and go away a few weeks after your body adjusts to the medication. But if you are concerned about side effects or drug interactions, or having trouble managing your medications, seek medical advice from a healthcare professional.