Moderate
carvedilol × Insulin
Alpha and beta blocker (non-selective β + α1)×Insulins and analogues (general card; individual products require separate cards)
Mechanism
Beta-blockers mask adrenergic hypoglycaemia symptoms (tachycardia, tremor, sweating). In diabetics on insulin, the risk of severe unrecognised hypoglycaemia rises.
Symptoms
Confusion, vision changes, loss of contact, seizures. Tachycardia, tremor, and sweating are suppressed — the patient misses the hypoglycaemia.
Management
Prescribe carvedilol cautiously in diabetes. In heart failure with reduced ejection fraction, carvedilol remains first-line (improves survival) — teach the patient to recognise hypoglycaemia by any unusual sensation. On insulin, intensify glucose self-monitoring (4 times daily) for the first month. For hypertension without heart failure, alternatives: ACE inhibitor or ARB with a diuretic.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Sources
- ADA: Standards of Care in Diabetes 2024 – pharmacologic approaches to glycemic treatment (2024)– Diabetes Care 2024;47(Suppl 1):S158-S178