Means, deplete catecholamines (reserpine, inhibitors), since they can cause severe bradycardia and hypotension.
Calcium channel blockers (verapamil, diltiazem) and antiarrhythmic drugs (especially class 1), because they can provoke severe hypotension and heart failure. Intravenous administration of these drugs in conjunction with taking carvedilol is contraindicated.
Tri tren side effects agonists (due to the possibility of hypertension, severe reflex bradycardia and asystole, and reducing beta-adrenoceptor blocking action of carvedilol).
- Clonidine and carvedilol may enhance each other’s ability to lower blood pressure and heart rate. In a joint application removal should be gradual, starting with carvedilol, then a few days could be gradually stopped receiving clonidine
- Digoxin (slows atrioventricular conduction);
- Insulin and hypoglycemic agents for oral use (due to increased hypotensive effect and masking symptoms of hypoglycemia);
- Nitrates and antihypertensives (clonidine, guanethidine, alpha-methyldopa, guanfacine, etc.) – Due to increased hypotensive effect and reduce the heart rate;
- The means for anesthesia (due to their negative inotropic action and hypotensive effect);
- Agents affecting the central nervous system (hypnotics, tranquilizers, tricyclic antidepressants, and ethyl alcohol) due to the possibility of mutual reinforcement effects;
- Nonsteroidal anti-inflammatory drugs (due to the reduction of hypotensive action due to decreased production of prostaglandins);
- Ergotamine (to take into account ergotamine vasoconstrictor effect);
- Xanthine derivatives (aminophylline, theophylline) – due to the reduction of beta-adrenoceptor blocking action.
Since carvedilol undergoes oxidative metabolism, the pharmacokinetics may change when the induction or inhibition of the enzyme cytochrome P 450. Therefore, the effect should be taken into account:
- Rifampicin (there is 70% reduction in the carvedilol concentration in the serum);
- Barbiturates (reduced effect of carvedilol)
- Cimetidine (increased bioavailability Carvedilol 30%);
- Digoxin (increases concentration of digoxin in the blood plasma);
- Inhibitors isoenzyme tri tren side effects (quinidine, fluoxetine, paroxetine, propafenone) can assume increasing concentrations of R (+) enantiomer of carvedilol;
- Cyclosporine (cyclosporine metabolism of carvedilol delay)
Patients with severe heart failure, with electrolyte imbalance, with a reduced level of blood pressure (less than 100 mm Hg) or in the elderly should be kept under close medical supervision for 2 hours after taking the first dose or after receiving the first dose increased, due to the risk of a sudden drop in blood pressure, orthostatic hypotension and syncope. The risk of these complications can be reduced with the appointment of the drug in the small initial doses and receiving it during the meal.
The dose should be reduced if the patient is marked bradycardia (heart rate less than 55 beats per minute)
Appointment of carvedilol in patients receiving cardiac glycosides, diuretics and / or angiotensin converting enzyme inhibitors for heart failure requires special care.
patients with heart failure if they initial systolic blood pressure less . Art. or are associated diseases – coronary heart disease, peripheral vascular disease or renal dysfunction, should frequently check the condition of the urinary system, because the treatment may affect renal function (usually temporarily). If marked inhibition of renal function, Talliton dose should be reduced or treatment should be discontinued.
In patients with angina tri tren side effects indiscriminate beta-blockers can cause chest pain. Although α 1 adrenoblokiruyuschee effect can prevent this action.
The appointment of the drug in unstable angina, as well as atrioventricular block I degree, requires attention, frequent ECG and careful medical monitoring of patients.
Treatment of patients with peripheral arterial disease requires attention and care. Like other beta-blockers, carvedilol may mask the symptoms of hypoglycaemia and adversely affect carbohydrate metabolism. In accordance with this treatment carvedilol diabetics require special attention and more frequent measurement of blood sugar. Furthermore, Talliton contains sucrose in its composition, which should also be taken into account when treating patients with diabetes.
Carvedilol may mask symptoms of increased thyroid function. With the sudden cancellation of the drug will probably gain hyperthyroidism and possible thyrotoxic crisis.
Treatment Talliton patients with established pheochromocytoma should not begin until the appropriate therapeutic blockade of the alpha-adrenergic receptors.
Treatment Talliton psoriasis patients requires an assessment of the benefit / risk as carvedilol may enhance disease or trigger the onset of symptoms.
Talliton each tablet contains 50 mg of lactose. This amount should be taken into account when lactase deficiency, galactosemia and malabsorption syndrome tri tren side effects.
Each tablet Talliton contains 12.5 mg of sucrose. This may be important in diabetes, hereditary fructose intolerance, glucose malabsorption / galactose or deficit sucrase / isomaltase.
Termination treatment should gradually reducing the dose.
Patients who use contact lenses should be warned that carvedilol reduces production of tear fluid.