carvedilol 12.5mg BID. The primary end points were the mean dynamic HR reduction and the mean dynamic diastolic BP (DBP) control in the last 4 h of the treatment period. Some beta-blockers, e.g. channel blocker can be added to their treatment regimen, e.g. Bananas. in Collaboration With EACTS. Metoprolol 1,2 bronchospasm IV 2.5-5 mg bolus over 2 min, up to 3 doses N/A hypotension, heart block, bradycardia, , HF succinate ER 25 See black box warnings for this drug Oral 25-100 mg twice daily. Also, your doctor may prescribe a beta blocker as one of several medications to lower your blood pressure. post-myocardial infarction is uncertain, www.goodfellowunit.org/podcast/rational-use-beta-blockers-linda-bryant, www.humanservices.gov.au/corporate/statistical-information-and-data/medicare-statistics, http://dx.doi.org/10.1111/j.1755-5922.2011.00306.x, http://dx.doi.org/10.1016/j.amjhyper.2005.09.009, www.medsafe.govt.nz/profs/datasheet/b/bosvatetab.pdf, http://dx.doi.org/10.1161/CIR.0b013e31829e8807, http://dx.doi.org/10.1002/14651858.CD002003.pub5, www.acc.org/latest-in-cardiology/articles/2017/01/20/09/36/how-long-should-we-continue-beta-blockers-after-mi, http://dx.doi.org/10.1016/j.amjmed.2014.05.032, http://dx.doi.org/org/10.1093/eurheartj/sup001, www.deepdyve.com/lp/wiley/beta-blockers-their-properties-and-use-in-hypertension-r8kWc0KnAN, http://dx.doi.org/10.1136/heartjnl-2016-309458, http://dx.doi.org/10.1371/journal.pone.0113048, http://dx.doi.org/10.1016/j.brainres.2006.06.107, Beta-blockers are a diverse group of medicines and prescribers should consider their different properties, along You need to take it on an empty stomach and you can't skip doses. In general, you should call or schedule an appointment if you have a sudden change in symptoms, especially ones related to your heart and circulatory system. Ministry of Health. tartrate 25 mg. Beta blockers generally arent used in people with asthma because of concerns that the medication may trigger severe asthma attacks. It works in the same manner as metoprolol in the body. Possible alternatives to metoprolol succinate for treating heart failure include bisoprolol and carvedilol. Cardiovasc Ther 2013;31:7683. J Clin Hypertens (Greenwich). The Task Force for the Management of Patients with Ventricular 25 After 20 minutes, the acute vitamin C infusion was maintained at the same rate while the bradykinin and sodium . and co-morbidities, e.g. 8 months and the mean daily dose of . Carvedilol, sustained release metoprolol, and bisoprolol all have relatively long half-lives . elevated heart rate, but 47.5 mg may be required for a patient with a significantly elevated heart rate. Consider TID or BID dosing with IR or ER formulation, based on resident pain level. bisoprolol and metoprolol both increase anti-hypertensive channel blocking. angina, a beta-blocker can usually be started at a standard dose. Atenolol. It has no intrinsic sympathomimetic activity. For example, . carvediolol or metoprolol, are metabolised Available from: Douglas Pharmaceuticals Ltd. Data sheet: BOSVATE. Beta-blockers are a class of medicines commonly used to treat a wide range of problems involving your heart and your circulatory system. In addition, the appropriate dosage . You may Food can enhance the levels of metoprolol in your body. A review of their pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension and ischaemic heart disease. . Beta Blocker approximate dose equivalents Carvedilol 12.5 mg BlD Labetalol 100 mg BID Atenolol 50 mg daily Bisoprolol 5 mg daily Propranolol . Is not subject to the Controlled Substances Act. There are no specific guidelines for withdrawing beta-blockers. Subjects will receive metoprolol succinate (Betaloc SR) at a dose of 47.5 mg once daily orally as SR tablets for a period of 4 weeks. There are many beta-blockers available, but some of the more common ones include: Starting: 3.125 mg twice a day for 2 weeks. MeSH Available from: Shu DF, Dong BR, Lin XF, et al. View this study on Beta.ClinicalTrials.gov, U.S. Department of Health and Human Services, The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. after myocardial infarction.11 Alternatives Metoprolol is a beta-adrenergic blocking agent (beta-blocker) that blocks the action of the sympathetic nervous system (a portion of the involuntary nervous system) and is used to treat high blood pressure (hypertension), heart pain (), congestive heart failure, abnormal heart rhythms, hyperthyroidism, and some neurologic conditions.Metoprolol also is used to prevent migraine headaches. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The ABPM determined blood pressure 3 times hourly in the daytime and once hourly in the nighttime. As seen in figure 1, the most commonly prescribed beta-blocker medications are metoprolol succinate and metoprolol tartrate. Bisoprolol, carvedilol or metoprolol. PloS One 2014;9:e113048. The doses of metoprolol succinate and tartrate are slightly different due to the difference Occasionally it may 8600 Rockville Pike From what my doctor told me, 12,5 mg of Metoprolol is similar . The difference between the nighttime heart rate at Week 12 treatment and of the baseline heart rate was calculated to measure the change of mean ambulatory nighttime heart rate at the end of the treatment. There is, however, little evidence to support the systematic use of metoprolol succinate over other medicines in this class. and transmitted securely. The difference between the mean ambulatory SBP observed in the last 4 hours after 12-week treatment and baseline was calculated to find out the change of mean ambulatory SBP at the end of the treatment. bisoprolol 5mg daily. The ABPM determined blood pressure 3 times hourly in the daytime and once hourly in the nighttime. It is important, however, not to confuse the different formulations of metoprolol when they are prescribed. Nebivolol is a racemate composed of d-Nebivolol and l-Nebivolol with the stereochemical designations of [SRRR]-nebivolol and [RSSS]-nebivolol, respectively. Bisoprolol (Zebeta) Esmolol (Brevibloc injection) Metoprolol tartrate (Lopressor) Metoprolol succinate (Toprol XL) Nebivolol . Du Q, Sun Y, Ding N, et al. Timolol 5mg BID. 2014 Jun;37(6):533-7 Nadolol 80mg daily. Survival With Oral d-Sotalol. G Ital Cardiol 2016;17:10870. that patients now gain less benefit from the use of beta-blockers than they did decades ago, There are no recent prospective randomised studies assessing the long-term benefits of beta-blockers in patients chest pain, even in those with no history of coronary heart disease. of further cardiac disease. "Bisoprolol" should take it less often than the first. Metoprolol ER/XL 100mg daily. Daily. for rhythm control include flecainide in younger patients or amiodarone in older patients. service delivery areas, and we are recognised nationally and internationally for our expertise and innovation. Atenolol is a much older drug and is now less often prescribed for cardiac patients. with ischaemic heart disease, but it is important that the beta-blocker is slowly titrated to maximum tolerated dose. A total of 454 drugs are known to interact with bisoprolol: A total of 496 drugs are known to interact with metoprolol: ** The Controlled Substances Act (CSA) schedule information displayed applies to substances regulated under federal law. Keywords provided by Merck KGaA, Darmstadt, Germany: Why Should I Register and Submit Results? Leafy green vegetables. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). and adverse effects.22, There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit : Dosages of 1.25 to 5 mg every 6-12 hours have been used in short-term management of patients unable to take oral tabs. carvedilol, also bind to alpha-adrenoceptors and prevent contraction of vascular smooth muscle. Cardioselective beta-blockers, e.g. Only monitoring data with valid data >=80% was used for analysis. processes. is no evidence that one beta-blocker is superior to another or that beta-blockers are superior to calcium channel blockers.8 The Learn why you might need them and their possible side effects. Metoprolol 50 mg PO BID [immediate release] with better outcomes.13 Beta-blockers may be more effective in younger patients with hypertension than older Metoprolol and diltiazem are used to treat high blood pressure (hypertension), heart pain (angina), and abnormal heart rhythms. official website and that any information you provide is encrypted post-myocardial infarction is uncertain). Online ahead of print. Patients receiving betablockers other than . Maintenance: 6.25 25 mg twice a day. These include: Your email address will not be published. Unauthorized use of these marks is strictly prohibited. Elderly: Oral: Initial: 25 mg/day; usual range: 25-300 mg/day. 2011. 40mg/day. The average final dose in that trial was 159 mg a day and 64% of patients tolerated the target dose of 200 mg a day. exclusively for rhythm control in patients with supraventricular and ventricular arrhythmias, but use 1997 Jun;22(3):171-9. doi: 10.1046/j.1365-2710.1997.8775087.x. Bisoprolol. The https:// ensures that you are connecting to the The overall adverse event rate was similar between the two groups. preferred for patients with co-existing chronic obstructive pulmonary disorder (COPD) because they cause less bronchoconstriction, 72% were prescribed metoprolol succinate; the seventh most prescribed medicine in New Zealand, 4% were prescribed carvedilol or propranolol, Reperfusion techniques and the routine use of statins and anti-platelet medicines post-myocardial infarction mean It also improves blood flow to the heart, which is important if you have a history of heart disease. Sotalol should be initiated and doses increased in a hospital with facilities for cardiac rhythm monitoring and assessment. Drug Comparisons Beta Blockers - Comparative properties and equivalent dosages of various beta blocker medications and protocols for clinical professionals. e.g. If someone adds a reply to one of your comments (or replies) you will recieve an email notifying you of this. Sotalol should not be used for rate control in atrial fibrillation due to its pro-arrhythmic action. 40% of reviewers reported a positive effect, while 34% reported a negative effect. When a beta-blocker is initiated, a slow upwards titration of dose is recommended to minimise adverse effects. 2016. Bisoprolol: 1.25 mg qd: 2.5 mg qd: Nebivolol: 1.25 mg qd: 2.5 mg qd: Metoprolol succinate: 25 mg qd: 50 mg qd: 1 more row. J Clin Pharm Ther. Malaise, vivid dreams, nightmares and in rare cases hallucinations may be caused by lipid-soluble beta-blockers crossing Winner = both. What is the most effective beta blocker? You can still add a fresh comment by scrolling to the bottom of the discussion and clicking the "Add a comment" button. such as sleep disturbances, Polypharmacy: bisoprolol is less likely to interact with other medicines, Renal dysfunction: consider dose adjustments for water-soluble beta-blockers, e.g. Begin treatment with a beta-blocker at a low dose and gradually increase this to the recommended dose or the maximum The primary end points were the mean dynamic HR reduction and the mean dynamic diastolic BP (DBP) control in the last 4 h of the treatment period. Beta-blockers are classified according to their adrenoceptor binding affinities (Table 1), the degree 19 hours. In addition to blocking 1 receptors, non-selective beta blockers also block beta-2 (2) receptors in the body. To view a report comparing 3 (or more) medications, please sign in or create an account. - Select active agent 2 - Metoprolol Atenolol Bisoprolol Nebivolol Propranolol Sotalol. If you have angina or AF, for example, other drugs that slow the heart rate, such as diltiazem or verapamil, may be substituted. Ohkuma S, Katsura M, Shibasaki M, et al. By intravenous injection. *Disclaimer: These are not typical starting doses. Initially 1.25 mg once daily for 1 week, dose to be taken in the morning, then increased if tolerated to 2.5 mg once daily for 1 week, then increased if tolerated to 3.75 mg once daily for 1 week, then increased if tolerated to 5 mg once daily for 4 weeks, then increased if tolerated to 7.5 mg once daily for 4 weeks, then increased if . Am. For other conditions, The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Bisoprolol and alcohol may have additive effects in lowering your blood pressure. Shalansky K, Sunderji R, et al. Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a In some cases, especially for adults over 65, its possible to use them for years or indefinitely. Objective: Bisoprolol, carvedilol and nebivolol have been shown to be effective in the treatment of heart failure. -, Cardiovasc Drugs Ther. Beta-blockers are the first-line treatment for long-term symptomatic rate control in patients with a range of cardiac Copyright 2021 GlobalRPH - Web Development by, Drug Comparisons Beta Blockers equivalent doses, HONcode standard for trust- worthy health, Pediatric Oncology: Diagnosis And Prognosis Communication. Prescribers are encouraged to use the pharmacological diversity of beta-blockers and the clinical characteristics of patients to individualise treatment and optimise care. Metoprolol, sold under the brand name Lopressor, among others, is a selective 1 receptor blocker medication. Bryant: government site. Since the first patients that were switched from carvedilol to metoprolol frequently experienced hypotension or bradycardia, treatment was modified by reducing the first doses of metoprolol to 50 mg of metoprolol, equivalent to 25 mg of carvedilol. The innovator brand (Betaloc) was also heavily marketed in New There is no evidence that one beta-blocker is superior to any other for the management of hypertension.13 If infarction is increased for older patients during the first month of withdrawal from cardioselective beta-blockers and heart failure.14 Bisoprolol or metoprolol succinate are usually prescribed as they are the most cardioselective Beta blockers aren t recommended as a first treatment if you have only high blood pressure. Propranolol and atenolol have been studied most intensely in hypertension. No significant clinical decisions should be made based on these images from this website without first consulting with a board-certified attending physician. Do Not Copy, Distribute or otherwise Disseminate without express permission. (HF-REF) after a diuretic has reduced the patients fluid overload. tachycardia. Cardiol. Metoprolol and Bisoprolol. the estimated daily infant dose of metoprolol received from breastmilk ranges from 0.05 mg to less than . of which varies within each class. metoprolol SR 100mg daily. Pharmaceutical Sciences. Atenolol 50 mg PO DAILY. National Library of Medicine The .gov means its official. Underuse of -blockers in heart failure and chronic obstructive pulmonary atenolol, celiprolol and nadolol; These changes often are temporary. The mean change in the blood pressure variability between the 24-hour blood pressure observed at Week 12 and baseline was calculated. Acetaminophen (Tylenol) four times daily to less frequent dosing or conversion to acetaminophen extended release (Tylenol ER) 325 mg QID/q6h. Beta blockers arent usually prescribed for high blood pressure unless other medications, such as diuretics, havent worked effectively. ACE inhibitors interfere with the conversion of . The equivalent dose of sustained release verapamil can be used once per day or divided into twice a day to better maintain . are immediate-release,* taken twice daily. 2013 ACCF/AHA Guideline for the Management of Heart Failure. as clear as they once were. Two measurements were made at least 1 to 2 minutes apart. Find out how bisoprolol treats high blood pressure (hypertension) and heart failure, and how to take it. patients and may be used to manage hypertension in females of reproductive age. . Beta-blockers or calcium channel blockers are recommended as the first-line anti-anginal medicines.7 There Beta Blocker Conversion Table. Bisoprolol 5mg daily. Here is a 2017 chart of the most popular beta-blockers. The drug is selective for beta-1 receptors. in weight of the two salts, but they are therapeutically equivalent, e.g. Beta-blockers are initiated alongside an ACE inhibitor in all patients with heart failure with reduced ejection fraction Heart rate response rate was calculated by using the number of subjects with heart rate response divided by total number of subjects and multiplied by 100. 2021 Sep 17. doi: 10.1007/s10557-021-07248-1. If I understand dosage equivalencies for Beta-Blockers, then 20mg of Bystolic once daily is equal to 100mg Metoprolol twice a day. Weber MA. Drugs R D. 2014 Dec;14(4):325-32. doi: 10.1007/s40268-014-0073-5. Bisoprolol is processed by both the liver and kidneys therefore does not require dose adjustments for patients with Information on the management of acute coronary syndromes is available from: Receptor (s) affected: 1 Selective. Tolerance to treatment bisoprolol and metoprolol, However, if you were taking 25 mg of atenolol, it makes sense that you would be initiated on a low dose of metoprolol succinate, around 25 to 50 mg. Information on the management of stable angina is available from: low blood sugar. If you notice mild side effects, don't stop taking the beta-blocker without talking to your doctor first . 2014. The maximum dose is 20 mg daily (single dose taken in the morning). Each ABPM lasted for at least 24 hours. Nighttime in this study was defined as 10:00 pm to 06:00 am. Detailed Description. Medicare statistics. metoprolol succinate 23.75 mg is equal to metoprolol . By working on the beta-1 receptor of the cardiac muscle cells, it yields both a chronotropic and inotropic effect. doi: 10.1002/j.1552-4604.1990.tb03499.x. Resident Editor: Patrick Azcarate, MD Metoprolol tartrate (twice daily) to metoprolol . Study record managers: refer to the Data Element Definitions if submitting registration or results information. According to studies, carvedilol and metoprolol are just as good at improving the chances of survival after a heart attack. Heart rate response was defined as decrease in heart rate from baseline >=10 percent (%). The dose conversion ratio of carvedilol to bisoprolol was 4.15 to 1 on average. the blood brain barrier.21 If a patient reports adverse effects related to the central nervous system that This item is 5 years and 8 months old; some content may no longer be current. 1990 Feb;30(S2):S61-5. Zealand before alternative options, e.g. Secondary end points included ambulatory monitoring of the BP and HR, safety and compliance. Treatment with beta-blockers--the value of an even plasma concentration over 24 h. The Combination of Beta-Blockers and ACE Inhibitors Across the Spectrum of Cardiovascular Diseases. The dose of bisoprolol will be escalated to 7.5 mg orally once daily for next 4 weeks (Weeks 4 to 8) and to 10 mg orally once daily for the next 4 weeks (Weeks 8 to 12), if clinic systolic blood pressure (SBP) was greater than or equal to (>=) 140 millimeters of mercury (mmHg) and/or diastolic blood pressure (DBP) was >=90 mmHg measured every 4 weeks. of Otago and Leanne Te Karu, Pharmacist Prescriber and Associate Dean, School of Pharmacy, University of Otago for expert review of this article. Choosing to participate in a study is an important personal decision. Clinic resting Heart Rate >=70 beats per minute (bpm), Patients who have signed informed consent. The initial dosage of metoprolol succinate ranges from 25-100 mg per day. that are less likely to cause fatigue and cold extremities than non-specific beta-blockers and are often Beta blockers. Low-fat dairy products. 40% of reviewers reported a positive effect, while 34% reported a negative effect. Causes, symptoms and basic methods of treatment of thrombophlebitis in pregnancy. to persist with treatment as long as their systolic blood pressure does not fall too low, e.g. dose is reduced and the patients cardiac receptors and sympathetic nerve activity down-regulate.3, 26. Pharmaceutical Claims Collection. 2.5 mg. 2.5-10mg. Patients with heart failure with preserved ejection fraction (HF-PEF) may also be prescribed a beta-blocker if they Your healthcare provider can advise you on when you should call or schedule an appointment related to taking beta-blockers. Bisoprolol is lipophilic and hydrophilic. Heart failure. Daytime in this study was defined as time between 06:00 am to 10:00 pm. The usual dose is 10 mg daily (single dose taken in the morning). Lancet Lond Engl 1996;348:712. Propranolol ER 80mg daily. Two measurements were made at least 1 to 2 minutes apart. Anti-oxidants help prevent inflammatory conditions and lower blood pressure. This is an evolving area of research meta-analysis of observational studies. Beta blockers can also affect your cholesterol and triglyceride levels. The ABPM determined blood pressure 3 times hourly in the daytime. Thank. Available from: Ladage D, Schwinger RHG, Brixius K. Cardio-selective beta-blocker: pharmacological evidence and their influence on treatment was modified by reducing the first doses of metoprolol to 50 mg of metoprolol, equivalent to 25 mg of carvedilol. The benefits of beta-blockers post-myocardial infarction are also no longer Bangalore S, Makani H, Radford M, et al. 2014 Feb;23(1):3-16 Metoprolol or bisoprolol. 95 ratings on Drugs.com. a beta-blocker is prescribed the choice is based on the presence of co-morbidities, prescriber experience and the patients be desirable in patients with peripheral artery disease but less beneficial in patients with heart failure or angina. An official website of the United States government. Cardiovasc Drugs Ther. Withdrawal symptoms of headache, palpitations, and tremor occurred in one of seven patients after pindolol, six of nine after propranolol, and three of eight after metoprolol. Beta-blockers that are metabolised by hepatic enzymes may also interact with medicines that are metabolised via the same pathway. Table 1: Properties of beta-blockers subsidised in New Zealand. Metoprolol tartrate, also known by the brand name Lopressor, is an immediate-release oral tablet that comes in strengths of 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg. Metoprolol succinate, also known by the brand name Toprol XL, is an extended-release oral tablet that comes in strengths of 25 mg, 50 mg, 100 mg, and 200 mg. RELATED: Metoprolol vs . Usual dose 50 mg 2-3 times a day, then increased if necessary up to 300 mg daily in divided doses. carvedilol or 100 mg metoprolol. Metoprolol succinate accounts for almost three-quarters of the beta-blockers dispensed in New Zealand. Record the patients heart rate and blood pressure before treatment is initiated and continue to monitor with heart failure. Methods: Therefore, we performed a randomized, double-blind, placebo-controlled, cross-over trial in 16 healthy males. Lowers blood pressure and controls heart rate. . 6.5 out of 10 from a total of 1000 mg QID/q6h. of randomized trials. -Blocker. Beta-blockers Secondary end points included ambulatory monitoring of the BP and . or metoprolol succinate will provide the maximum effect with the minimum amount of adverse effects. beta-blockers, but there is evidence of benefit for a number of other beta-blockers and international guidelines do not Clinical outcomes with -blockers for myocardial infarction: a meta-analysis Drug: Metoprolol Metoprolol 50 mg, Metoprolol 100 . Switching between oral and IV dosage forms: Equivalent beta-blocking effect is achieved in 2.5:1 (oral-to-IV) ratio. Cardiovasc Drugs Ther. 2010 Sep;23(9):1023-30 Only monitoring data with valid data >=80% was used for analysis. Available from: National Institute for Health and Care Excellence (NICE). 77% of reviewers reported a positive effect, while 12% reported a negative . block and stimulate beta-adrenoceptors causing less bradycardia and peripheral vasoconstriction.5 This may This selectivity is reduced at higher doses so the lowest effective dose should be used. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Yancy C, Jessup M, Bozkurt B, et al. Atenolol, acebutolol, metoprolol, nadolol, oxprenolol, and propranolol are licensed to treat atrial fibrillation (AF). Carvedilol may lower blood pressure more than metoprolol. Last Modified: May 11, 2016. Available 2016. Both medications significantly reduce the risk of another heart attack from occurring, and there are no obvious differences between the 2 on this front. All beta-blockers produce competitive antagonism of beta-adrenoceptors in the autonomic nervous system.3 This . Beta blockers cause your heart to beat more slowly and with less force, which lowers blood pressure. They also are sometimes used to treat conditions related to your brain and nervous system. Its chemical name is ()1-(isopropylamino)-3-[p-(2-methoxyethyl) phenoxy]-2-propanol succinate (2:1) (salt). [Selective inhibitor of beta1-adrenergic receptors; competitively blocks beta1-receptors, with little or no effect on beta2-receptors at doses <10 mg] Dosing (Adults) : Treatment of hypertension, alone or in combination with other agents: Supraventricular tachycardia or gradual control of postoperative tachycardia/hypertension :: IV: Loading dose: 500 mcg/kg over 1 minute; follow with a 50 mcg/kg/minute infusion for 4 minutes; response to this initial infusion rate may be a rough indication of the responsiveness of the ventricular rate. All beta-blockers are considered to be equally effective although bisprolol or metoprolol may be preferred. these as the dose is titrated upwards.12 Adverse effects will often resolve and patients can be encouraged Each ABPM lasted for at least 24 hours. than non-selective beta-blockers.21 However, peripheral vasoconstriction may still occur due to the reduction Each ABPM lasted for at least 24 hours. required long term to prevent angina or if there is poor ventricular function. We have now added the ability to add replies to a comment. New Zealand 2012 guidelines for the management of non-ST elevation acute coronary syndromes. Although these images are curated, as they are sourced from the community, there is no way to guarantee a consistent standard of accuracy and quality across the library of images. The difference between the mean ABPM observed in the last 24 hours at Week 12 and baseline was calculated to find out the change of mean ABPM at the end of the treatment. Disclaimer. (less than 400 mg within three hours) has a conversion rate of 60 to 70 percent at three hours after treatment and up . Further information on beta-blockers is available in the podcast: the Rational use of beta-blockers with Dr Linda The participants then received Metoprolol at a dose of 50 mg daily for 4 weeks, followed by 100 mg daily for another 4 weeks (i.e., weeks 9-16 in total). . If the patients were taking beta-blockers other than carvedilol, their dose will be calculated into the equivalent dose of carvedilol .