Patient Group Direction for the supply of Carvedilol 3.125mg-25mg tablets to
heart failure patients attending heart failure clinics or on home visits in NHS
Borders
This document authorises the supply or administration of carvedilol 3.125mg
tablets twice daily up to maximum 25mg tablets twice daily, orally by cardiac
specialist/heart failure nurses to heart failure patients who meet the criteria for
inclusion under the terms of the document
The cardiac specialist/heart failure nurse seeking to supply carvedilol 3.125mg
tablets twice daily up to maximum 25mg twice daily tablets, orally; must
ensure that all clients have been screened and meet the criteria before supply
takes place
The purpose of this Patient Group Direction is: to ensure patient on optimum
dose of Carvedilol allowing continuity of care and reduce visits to GP
This direction was authorised on: October 2011
The direction will be reviewed by: October 2013
Clinician Responsible for Training and Review: Gillian Donaldson
PGD reviewed by: Helen Oxenham, Gillian Donaldson
Cardiology PGD no 3: Carvedilol 3.125mg-25mg tablets
Page 1
Patient Group Direction for supply of carvedilol 3.125mg tablets up to 25 mg
tablets orally without a prescription for a named individual by cardiac
specialist nurses/heart failure nurses employed by NHS Borders in Borders
General Hospital or on community home visits
1. This Patient Group Direction relates to the following specific preparation:
Name of medicine, Carvedilol 3.125mg, 6.25mg, 12.5mg, 25mg tablets
strength,
Oral formulation
formulation
Legal status
Prescription only medicine (POM)
Storage
Store in a dry place below 25 degrees C and
protect from light
Dose
3.125mg twice daily titrated as tolerated at
intervals of not less than two weeks to maximum
25mg twice daily in patients with severe chronic
heart failure. The dose of carvedilol should double
at each increase.
In patients weighing less than 85kg with mild to
moderate chronic heart failure the maximum daily
dose is 25mg twice daily.
In patients weighing more than 85kg with mild to
moderate chronic heart failure the maximum daily
dose is 50mg twice daily.
Route/method
Oral
Frequency
Twice daily
Total dose Quantity
As appropriate per titration
(Maximum/Minimum)
Advice to Patients
 Explain that treatment given as much to
prevent worsening of heart failure as to
improve symptoms. If symptomatic
improvement occurs this may develop slowly
over 3-6 months or longer.
Relevant Warnings
 Contact G.P or heart failure nurse if any
increased breathlessness/wheeze/dizziness/
heart failure symptoms. Temporary
symptomatic deterioration may occur (2030% cases) during initiation. This can usually
be easily managed by adjusting other
Cardiology PGD no 3: Carvedilol 3.125mg-25mg tablets
Page 2
medication.
 Do not stop taking without consulting doctor
or heart failure nurse unless severe side
effects
 If diabetic may mask symptoms of
hypoglycaemic episodes and enhance
hypoglycaemia
 Encourage patients to weigh themselves
daily and to consult doctor or heart failure
nurse if they have persistent weight gain.
Follow up
Arrangements
Heart failure nurse will follow up patient within no
more than one month to titrate dose further if
tolerated
2. Clinical condition
Clinical Condition
to be treated
Adults with stable chronic mild /moderate/severe
heart failure with reduced systolic ventricular
function
Criteria for inclusion
Adults with clinical condition above and:
 No signs of acute heart failure on clinical
examination
 Pulse greater than 60bpm
 Systolic BP greater than 90mmHg (If lower
discuss with consultant cardiologist)
Criteria for
exclusion
















Decompensated heart failure
Marked bradycardia (Less than 60bpm)
Asthma/severe COPD
Hypotension (Systolic less than 90mmHg)
Sick sinus syndrome
Pregnancy/breast feeding
Second/third degree blocks
First degree block (discuss with cardiologist)
Sinoatrial block
Peripheral arterial disease
Untreated Phaeochromocytoma
Acute failure within past 6 weeks
Change in therapy in past 2 weeks
Hypersensitivity to carvedilol or any
excipients
Patients prescribed any of the following:
verapamil, diltiazem, phenytoin, clonidine,
moxonidine, methyldopa, flecaininde,
propafenone, disopyramide
Patients prescribed ciclosporin
Action if excluded
Inform consultant cardiologist/physician
Action if declines
Inform Referring doctor and document informed
refusal
Interactions with

Enhanced hypotensive effects with other
Cardiology PGD no 3: Carvedilol 3.125mg-25mg tablets
Page 3
other medicaments
and other forms of
interaction
medications including ACE inhibitors/calcium
channel blockers, tricyclic antidepressants
(e.g. amitriptyline), phenothiazines (e.g.
chlorpromazine), -blockers (e.g. tamsulosin),
MAOIs, nitrates, baclofen, tizanidine (See
B.N.F) Alcohol
 Increased myocardial depression with other
anti-arrhythmics e.g. amiodarone, digoxin
(see B.N.F)
 Insulin and oral antidiabetic drugs enhanced effects
 Ciclosporin – carvedilol may affect
ciclosporin levels – do not co-prescribe
Check BNF for other medication in combination
may have enhanced hypotensive effects.
3. Records-Copy to patients medical record, specialist nursing record and G.P
1. The following records should be kept (either paper or computer based):The GP practice, clinic, hospital, and ward or department
The patient name and CHI number
The medicine name, dose, route, time of dose(s), and where appropriate,
start date, number of doses and or period of time, for which the medicine is
to be supplied or administered
Drug batch number and expiry
The signature and printed name of the approved healthcare professional
that supplied or administered the medicine
The patient group direction title and/or number
Whether patient met the inclusion criteria and whether the exclusion
criteria were assessed
Quantity supplied / received and current stock balance
2. Preparation, audit trail, data collection and reconciliation:Stock balances should be reconcilable with receipts, administration,
records and disposals on a patient by patient basis.
3. Storage: - Store in a dry place below 25°C and protected from light
4. Professional Responsibility  All Health Professionals will ensure he/she has the relevant training and is
competent in all aspects of medication, including contra-indications
and the recognition and treatment of adverse effects. He/she will
attend training updates as appropriate. For those involved in
immunization, regular anaphylaxis updates are mandatory.
 Nurses will have due regard for the NMC Code of Professional Conduct,
standards for conduct, performance and ethics (2008) and NMC
Standards for Medicines Management (2008)
5. References
 British National Formulary (BNF) current edition http://bnf.org/bnf/index.htm
 Borders Joint Formulary (BJF)
http://intranet/new_intranet/microsites/index.asp?siteid=65&uid=1


SPC Eucardic www.medicines.org.uk
NICE Heart Failure Guidelines
Cardiology PGD no 3: Carvedilol 3.125mg-25mg tablets
Page 4
Patient Group Direction for administration of carvedilol 3.125mg-25mg tablets to
heart failure patients attending heart failure clinics or on home visits by registered
nurses employed by NHS Borders
This Patient Group Direction is approved for use by the under-signed :
Job Title
Name
Senior Doctor/Dentist
for relevant clinical
area
Ross Cameron
NHS Borders Director
of Pharmacy
Alison Wilson
NHS Borders Senior
Health Professional for
Clinical Area
Sheena Wright
Signed
Date
PGD AUTHORISED ON ……/……/……..
Signed by ADTC CHAIRPERSON: ………………………………………………..
Name: …………………………………………………………………………………
The Health Professionals named below, being employees of NHS Borders are
authorised to provide and/or administer this medication under this Patient Group
Direction and agree to provide and/or administer this medication in accordance
with this Patient Group Direction
Name of Health
Professional
Job Title
Cardiology PGD no 3: Carvedilol 3.125mg-25mg tablets
Signed
Date
Page 5