Additional benefits for carvedilol (Coreg)

[JAMESFETT]

Another recent report in the medical literature* indicates that carvedilol (Coreg in USA) benefits heart function and recovery in a variety of ways in addition to the improved circulation/pumping benefits. These additional ways involve the immune system and underlying abnormalities of dilated cardiomyopathy and PPCM. The additional ways are: antiinflammatory (effect against myocarditis), antifibrosis (scarring in heart), antioxidative (nitric oxide which can decrease heart muscle strength), and immunomodulatory (changing the abnormal immune system functions involved). These are other reasons to prefer the use of this medication as the beta-blocker of choice.

[* European Journal of Heart Failure 2005;7:444-52.]

James

[Erin]

Dr. Fett, I was prescribed 6.25 mg. Coreg BID and it was never increased. Do these benefits still occur despite no administration of max dose?

[JAMESFETT]

Yes, the benefits are there, but we always try to reach "maximum tolerable" benefits. If, with the smaller dosages you have normal function, no need to increase. But if one does not have normal function, is still symptomatic, has decreased exercise tolerance, it is usually desirable to increase the dosage in gradual steps until the benefit is there, up to the 25 mg two times per day goal, provided no bothersome side effects.

James

[jasper]

Will there always be some bothersome side effects to some degree? The "brain fog" and fatigue just seem to hang on. I have been at the target dose for a year now. While it has improved, there are still days it really gets to me!
Jennifer

[JAMESFETT]

I think that most often most side effects lessen and often disappear. I hope that still happens for you. However, if too many persist and it is too disagreeable then one should not feel badly about going to an alternative, which usually is long-acting metoprolol. Bisoprolol is also an acceptable alternative.

James

[rileysmom]

What effects would it have (if any) on someone with the PPCM & MS? You said in the benefits post there were some auto immune benefits, how would that effect ms?

[JAMESFETT]

By MS, do you mean multiple sclerosis or mitral stenosis? I think you mean multiple sclerosis. The autoimmune effects are on cytokines, T-lymphocytes, chemokines, elements involved in immune function at the molecular level. While some of those same mechanisms are involved in multiple sclerosis, there is no known benefit for MS from carvedilol. Basically, the carvedilol helps to cool down an overactive immune system in PPCM. The same is true for ACE-inhibitors and angiotensin receptor blockers (ARB's) that sometimes must be substituted for ACE-inhibitors, especially for those who get an ACE-I cough. Do you have MS? Are you on any immune-affecting treatments? Best wishes.

James

[LauraNP]

Interesting info..

I've been back on Coreg for about 2 months now and feeling pretty well. I'm hoping for improvement at my next echo in March.

[JAMESFETT]

Feeling well often means improvement in function, so let's keep our fingers crossed and our hopes up.

JDF

[rileysmom]

Sorry, yes I meant Multiple Sclerosis -- I actually have no problems with the ms now, so I'm not on anything for it, hopefully it stays dormant and I won't have to. I just wondered about the coreg w/it.

[JAMESFETT]

That's so good. I'm glad your MS is doing well. Let's just suppose that the effects of coreg are beneficial in PPCM to the immune system--for which there is a lot of evidence that indeed it is. If you are still on coreg, perhaps there could be a beneficial cross-over in helping with the immune system in MS. I try to listen very closely to what patients are reporting.

JDF