All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor ----------------------------------------------------------- The upper section of this document are DIRECT QUOTES from SmithKline Beecham of possible interest to CHFers: ---------------------------------------------------------- "In congestive heart failure patients with diabetes, Coreg therapy may lead to worsening hyperglycemia, which responds to intensification of hyperglycemic therapy. It is recommended that blood glucose be monitored when Coreg dosing is initiated, adjusted or discontinued." "Always take Coreg with food." "Digoxin concentrations are increased by about 15% when Coreg and Digoxin are administered concomitantly. Both Digoxin and Coreg slow AV conduction. Therefore, increased monitoring of Digoxin is recommended when initiating, adjusting or discontinuing Coreg." "Agents with beta-blocking properties may enhance the blood sugar reducing effect of insulin and oral hypoglycemics. Therefore in patients taking insulin or oral hypoglycemics, regular monitoring of blood glucose is recommended." "Less than or equal to 1% of participants suffered nervousness, sleep disorder, aggravated depression, impaired concentration, decreased libido (sex drive), tinnitus (ringing in ears), micturition frequency (peeing a lot or feeling like you need to pee a lot)" (taken from a table) "The recommended starting dose of Coreg is 3.125mg twice daily for two weeks. If this dose is tolerated it can then be increased to 6.25mg twice daily. Dosing should then be doubled every two weeks to the highest level tolerated by the patient. At initiation of each new dose, patients should be observed for signs of dizziness or lightheadedness for one hour. The maximum recommended dose is 25mg twice daily in patients weighing less than 85KG (187 lbs) and 50mg twice daily in patients weighing more than 85 KG. Coreg should be taken with food to slow the rate of absorption and reduce the incidence of orthostatic effects." "Before each dose increase the patient should be seen in the office and evaluated for symptoms of worsening heart failure, vasodilation (dizziness, lightheadedness, symptomatic low blood pressure) or low heart rate in order to determine the tolerability of Coreg. Transient worsening of heart failure may be treated with increased doses of diuretics although occasionally it is necessary to lower the dose of Coreg or temporarily discontinue it. Symptoms of vasodilation often respond to a reduction in the dose of diuretics or Ace Inhibitor. If these changes do not relieve symptoms, the dose of Coreg may be decreased. The dose of Coreg should not be increased until symptoms of worsening heart failure or vasodilation have been stabilized." "Worsening heart failure or fluid retention may occur during up-titration of Coreg. If such symptoms occur, diuretics should be increased and the Coreg dose should not be advanced until clinical stability resumes. Ocassionally, it is necessary to lower the Coreg dose or temporarily discontinue it. Such episodes do not preclude subsequent successful titration of Coreg." "If pulse rate drops below 55 beats per minute, the dosage should be reduced." "Exercise tolerance was the primary endpoint in 3 studies; in none was a statistically significant effect found." ------------------------------------------------------- Jon's notes: I studied the congestive heart failure trials of Coreg at length (what Medspeak!) but only skimmed over the high blood pressure trials - just something to keep in mind while reading my notes. Dizziness was the primary side effect of Coreg in trials for congestive heart failure, but very few people withdrew due to this, so it may be assumed that it passes as you get used to the drug. 33% of all participants got dizzy at some point in their Coreg treatment. Fatigue was the next most experienced side effect in the congestive heart failure trials of Coreg, with 24% of all participants reporting increased fatigue during the trial. It should be noted, however, that less than 1% of participants withdrew from the trial due to fatigue, so it can usually (but not always) be endured until your body starts tolerating the drug better. Chest pain was next with 14% of participants suffering increased chest pain temporarily. Less than 1/10 of 1% withdrew for this reason, so it obviously passes as you get used to the drug. Diarrhea and hyperglycemia were next with 12 - 14% of participants suffering these side effects, but again, very few people withdrew due to these side effects. Low heart rate and low blood pressure were next, with about 8-9% of participants reporting these side effects. 1% withdrew for low heart rate but *over 3%* withdrew for low blood pressure, so this is one to beware of. I'm not sure how to throw this in, but it seems important: Upper respiratory tract infections were reported by 18% of study participants. Our immune response may be lowered by Coreg so watch out for common infections - get them treated immediately before they worsen! Regarding sexual functioning, 1 - 2% of those on Coreg will become impotent. Since there were equal numbers of women in the trial, I assume this actually translates to 2 - 4% of men suffering impotence due to the drug.