What time of day should I take carvedilol?

It is recommended that carvedilol should be taken at the same time every day and always with food.^1-7

Carvedilol is a beta-blocker that comes in two forms – the immediate-release tablet and the extended-release capsules. Carvedilol immediate-release tablet is usually taken twice a day, with its effect lasting approximately seven to ten hours.⁸ Carvedilol extended-release capsule is usually taken once a day, with its effect lasting about 24 hours.⁹

The Hygia Chronotherapy Trial compared clinical results for patients taking their antihypertensive medication upon awakening with those taking their medication at bedtime (n=19.084).¹⁰ Ambulatory blood pressure (BP) readings, sleep time BP, and cardiovascular outcomes were all improved in those taking medication at bedtime. A 45% relative reduction in cardiovascular disease (CVD) events was achieved by those consuming their blood pressure medications at bedtime compared to those taking medications upon awakening. The absolute reduction in risk was 5.4%.¹¹ 

Patients in the Hygia study continued on the medications they were taking at the time of enlistment into the study.¹⁰ Of those taking medication upon awakening, 22% were taking beta-blockers, like carvedilol; 17% of patients taking bedtime medication were taking beta-blockers. The authors of the Hygia study point out that there may be medications which do not result in better CVD outcomes when given at bedtime.

^References

1. APO-CARVEDILOL [package insert]. Toronto, Canada: Apotex Pharmaceutical Holdings Inc.; 2015.
2. AURO-CARVEDILOL [package insert]. Ontario, CA: Aurobindo Pharma Inc.; 2013.
3. COREG [package insert]. Ciales, PR: GK Pharmaceuticals Contract Manufacturing Operations; 2008.
4. COREG CR [package insert]. Ciales, PR: GK Pharmaceuticals Contract Manufacturing Operations; 2008.
5. U.S. National Library of Medicine. Carvedilol (By mouth). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009479/?report=details. Accessed August 21, 2018.
6. U.S. National Library of Medicine. Carvedilol. MedlinePlus. https://medlineplus.gov/druginfo/meds/a697042.html. Accessed August 21, 2018.
7. U.S. National Library of Medicine. CARVEDILOL-carvedilol tablet, coated. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7d485d38-5d43-4a54-bc63-82734035c66a. Accessed August 27, 2018.
8. Morgan T. Clinical pharmacokinetics and pharmacodynamics of carvedilol. Clin Pharmacokinet. 1994;26(5):335-346. 1994.
9. Tenero DM, Henderson LS, Baidoo CA, et al. Pharmacokinetic properties of a new controlled-release formulation of carvedilol. Am J Cardiol. 2006;98(7, Supplement 1):5-16.

10. Hermida RC, Crespo JJ, Domínguez-Sardiña M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J. October 2019. doi:10.1093/eurheartj/ehz754
11. NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals. https://www.jwatch.org/na50538/2019/12/26/antihypertension-medications-might-best-be-taken-night. Accessed January 24, 2020.