MajorAlpha and beta blocker (non-selective β + α1)×Non-dihydropyridine calcium channel blocker
Updated · Methodology
Mechanism
Non-dihydropyridine calcium channel blocker (verapamil) + beta-blocker (carvedilol) – additive AV node blockade and negative inotropic effect. Carvedilol has additional α1-blockade, amplifying hypotension.
Symptoms
Bradycardia (heart rate below 50/min), dizziness, syncope. ECG: first- to second-degree AV block. Older patients: fall risk.
Management
Avoid the combination. For atrial fibrillation rate control, choose carvedilol + digoxin (instead of verapamil), or verapamil with carvedilol withdrawn. In heart failure, carvedilol is preferred (benefit proven in COPERNICUS and CIBIS).
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.
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Sources
- ESC: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– McDonagh TA et al. Eur Heart J 2021;42:3599-3726
- AEMPS: Ficha técnica: Carvedilol (nº registro 66230), sección 4.5 (2025)– AEMPS, CIMA, nº registro 66230, sección 4.5