Tell your doctor if you are taking, have recently taken or might take any other medicines including medicines obtained without a prescription, herbal medicines, especially any of the following:

• other medicines for your heart or blood pressure including alpha blockers (e.g. doxazosin), calcium channel blockers (e.g. verapamil, diltiazem), medicine for an irregular heart rhythm (e.g. quinidine, flecainide, amiodarone), nitrates (e.g. isosorbide mononitrate), digoxin, reserpine
• barbiturates, carbamazepine are the medicines to treat epilepsy and these will reduce the BP lowering effect of carvedilol
• cinacalcet, to treat high blood levels of calcium
• bupropion, to treat nicotine addiction
• fluconazole, to treat fungal infections
• clonidine, for high blood pressure or migraines; if stopping treatment, Carvedilol treatment should be stopped a few days before slowly reducing the clonidine dose
• antibiotics such as rifampicin, erythromycin
• cimetidine, to treat stomach ulcers, heartburn
• ciclosporin, an immunosuppressant used after organ transplants
• antidepressants (to treat depression) such as monoamine oxidase inhibitors (MAOIs e.g. phenelzine), paroxetine, fluoxetine, amitriptyline
• antidiabetic medicine, including insulin, as carvedilol can increase the effect of medicines as well as hide the symptoms of low blood sugar (feeling sick, weak and sweating)
• sympathomimetics such as pseudoephedrine (to treat colds), adrenaline (epinephrine) and isoprenaline (heart stimulants), noradrenaline (norepinephrine)
• neuromuscular blocking medicine (to reduce muscle tension)
• medicines for breathing problems (e.g. salbutamol, formoterol)
• ergotamine, for migraine
• certain painkillers (NSAIDs) e.g. ibuprofen
• oestrogens (hormones)
• corticosteroids e.g. prednisolone

• Always take this medicine exactly as your doctor has told you
• Swallow the medicine with at least half a glass of water
• You can take with or without food. However, patients with heart failure should take the medicine with food to reduce the risk of dizziness when suddenly standing up
• If you feel the effects are too strong or weak, talk to your doctor

To treat high blood pressure

• The recommended starting dose is 12.5 mg taken once a day for the first 2 days, then 25 mg once a day
• If necessary the dose may be increased to a maximum of 50 mg daily, in either one or two doses
• If you are elderly, your doctor may increase the dose more slowly

Angina

• The recommended starting dose is 12.5 mg taken twice a day for the first 2 days, then 25 mg twice a day
• If needed your doctor may decide to slowly increase the dose further, to the maximum of 100 mg
• The recommended maximum dose for elderly patients is 25 mg twice a day

Heart failure

• The recommended starting dose is 3.125 mg twice a day for two weeks
• Your doctor may decide to increase your dose in stages every 2 weeks until the dose is right for you
• The maximum recommended dose is between 25 mg and 50 mg twice a day, depending on your weight
• The maximum recommended dose in severe heart failure is 25 mg twice a day
• If CARVIL treatment is stopped for more than two weeks, the dose should be restarted at 3.125 mg twice daily and slowly increased as above
• If you have liver problems your doctor may give you a lower dose than those stated above

If you take more CARVIL

• If you take more CARVIL than you should, contact your doctor or casualty department immediately

If you forget to take CARVIL

• If you forget to take a dose of CARVIL take it as soon as you remember unless it is nearly time for your next dose
• Do not take a double dose to make up for a forgotten dose

If you stop taking CARVIL

• If you suddenly stop taking CARVIL you are likely to suffer from side effects. If needed your doctor will reduce your treatment slowly