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Coreg vs Bystolic
Introduction
For patients with hypertension or various types of heart conditions, certain medications that control and manage the workload of the heart can significantly improve quality of life. Coreg and Bystolic are two such drugs often prescribed for these conditions. Both work by blocking specific receptors in the body's cardiovascular system, but their effects differ slightly due to their unique pharmacological properties. Coreg, also known as carvedilol, is classified as a non-selective beta blocker and alpha-1 receptor antagonist affecting both beta and alpha receptors throughout the body. This broad range action allows it not only to lower blood pressure but also reduce strain on the heart muscle itself. On the other hand, Bystolic (nebivolol) is a selective beta-1 receptor blocker which primarily affects heart rate without significant impact on bronchial or vascular smooth muscles.
Coreg vs Bystolic Side By Side
| Attribute | Coreg | Bystolic |
|---|---|---|
| Brand Name | Coreg | Bystolic |
| Contraindications | Worsening symptoms of heart failure, certain types of medications including second-generation antipsychotic drugs. | Worsening symptoms of heart failure, certain types of medications including second-generation antipsychotic drugs. |
| Cost | Brand name: around $225 for 30 tablets of 25 mg. Generic: from about $0.15 to $0.65 per day depending on dosage. | Brand name: about $160 for 30 tablets of 5 mg. Generic: between approximately $.90 and almost over two dollars daily for typical dosages. |
| Generic Name | Carvedilol | Nebivolol |
| Most Serious Side Effect | Severe liver disease symptoms, unusually slow heartbeat and lightheadedness or fainting. | Signs of a strong allergic reaction, unusual weight gain or fluid retention, a slow heart rate (bradycardia). |
| Severe Drug Interactions | Certain types of medications including second-generation antipsychotic drugs. | Certain types of medications including second-generation antipsychotic drugs. |
| Typical Dose | 3.125–50 mg twice daily | 5 mg/day, can be increased to 10 mg/day, up to a maximum of 20-40 mg per day |
What is Coreg?
Carvedilol (the generic name for Coreg) was a significant advancement in the class of drugs known as beta blockers, which are used to treat conditions like hypertension and heart failure. Carvedilol was first approved by the FDA in 1995. Coreg blocks the action of certain natural substances in your body, such as epinephrine, on the heart and blood vessels. This results in lowered blood pressure, strain on the heart and it helps prevent strokes, heart attacks, and kidney problems.
On the other hand is Nebivolol (Bystolic), another drug from the beta blocker family that received FDA approval much later than Carvedilol - in 2007. Bystolic works similarly to lower blood pressure but has a more selective influence only on certain receptors within your cardiovascular system resulting potentially fewer side effects compared to other non-selective beta blockers like carvedilol.
What conditions is Coreg approved to treat?
Coreg is approved for the treatment of a variety of cardiac conditions:
- Chronic heart failure
- Left ventricular dysfunction following myocardial infarction, commonly known as heart attack
- Hypertension, also known as high blood pressure
How does Coreg help with these illnesses?
Coreg (Carvedilol) aids in managing heart failure and hypertension by decreasing the amount of adrenaline that the body releases, thus reducing strain on the cardiovascular system. It accomplishes this by inhibiting alpha and beta-adrenergic receptors which are primarily responsible for regulating heart rate and blood vessel dilation. Adrenaline is a hormone that increases heart rate, blood pressure, among other functions when your body is under stress. It's thought that individuals with certain cardiovascular conditions have relatively higher levels of adrenaline which can put unnecessary strain on their hearts. Therefore, by moderating adrenaline release through receptor inhibition, Coreg can limit the negative effects of these conditions and help patients manage their symptoms more effectively.
Bystolic (Nebivolol), like Coreg, also helps to manage hypertension but operates slightly differently as it specifically targets only beta-1 adrenergic receptors - making it a selective inhibitor compared to Coreg's non-selective approach.
What is Bystolic?
Bystolic is a brand name for nebivolol, which is a beta blocker, meaning it helps reduce the workload on your heart and helps it to beat more regularly. This action can be beneficial in treating high blood pressure (hypertension). It does this by blocking the effects of certain natural substances such as adrenaline on the heart and blood vessels. Nebivolol was first approved by the FDA in 2007. Unlike Coreg (Carvedilol), another commonly used beta-blocker, Bystolic has a higher selectivity for beta1 receptors that are primarily located in cardiac tissue. This means its side effect profile could potentially differ from other nonselective beta blockers like Coreg, especially concerning less bronchospasm or constriction of airways making it safer for patients with respiratory issues like asthma or COPD. The potential benefits of Bystolic may be particularly advantageous for hypertensive patients who have not responded well to typical antihypertensive medications.
What conditions is Bystolic approved to treat?
Bystolic, also known by its generic name Nebivolol, is approved for the treatment of:
- Hypertension (also referred to as high blood pressure) This medication falls under the category of beta blockers, which work primarily by slowing down heart rate and reducing blood vessel contraction in the heart, brain, and throughout the body.
How does Bystolic help with these illnesses?
Nebivolol, known by the brand name Bystolic, is a beta-blocker that works by blocking the effects of the hormone epinephrine, also known as adrenaline. It's heavily involved in several processes within the body like controlling heart rate and blood pressure while promoting vasodilation to enhance blood flow. As with norepinephrine, elevated levels of adrenaline have been linked to conditions such as hypertension and angina. Bystolic effectively reduces these symptoms by lowering both your resting and exercise-stimulated heart rates and reducing your body's stress response.
Its action on nitric oxide release may also contribute towards its efficacy as a uniquely cardioselective beta-blocker. Unlike Coreg (Carvedilol), which is non-selective and acts on both alpha-1 receptors along with Beta 1 & 2 receptors; Bystolic specifically targets Beta-1 adrenergic receptors located predominantly in cardiac tissue making it more suitable for patients who are sensitive to other systemic effects produced by non-selective blockers or those not responding well to other typical antihypertensive medications.
How effective are both Coreg and Bystolic?
Carvedilol (Coreg) and nebivolol (Bystolic) both have established histories of success in treating patients with heart failure and hypertension, being approved by the FDA only a few years apart. Both are classified as beta-blockers but work slightly differently: carvedilol is a non-selective beta blocker that also blocks alpha-1 receptors, while nebivolol acts selectively on β1 adrenergic receptors and has additional nitric oxide-mediated vasodilatory properties.
The effectiveness of carvedilol and nebivolol in managing symptoms associated with these conditions was directly studied in several clinical trials. For instance, a 2017 study exhibited similar efficacy between the two drugs for managing systolic blood pressure.
A review of meta-analysis reports on carvedilol demonstrated its effectiveness in reducing mortality rates among heart failure patients starting from the initial treatment periods. Its side effect profile is comparable to many other beta-blockers, though it may be better tolerated due to its vasodilation effects brought about by alpha-1 receptor blockade.
On the other hand, nebivolol seems to have fewer classic side effects associated with older beta blockers such as fatigue or sexual dysfunction due to its selectivity for β1 receptors and ability to enhance nitric oxide release leading to dilation of blood vessels. Nebivolol's unique pharmacological properties make it an optimal choice for certain patient populations who might not respond well or tolerate non-selective blockers like carvedilol.
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At what dose is Coreg typically prescribed?
Oral dosages of Coreg typically range from 3.125–50 mg twice daily, but studies have indicated that a starting dose of 3.125 mg twice daily is sufficient for treating mild to severe heart failure in most people. The dosage can be increased after a couple of weeks if the initial response is not satisfactory. On the other hand, Bystolic is usually started at 5 mg once daily, and the dose may be increased every two weeks up to a maximum of 40 mg per day based on patient response. In either medication regimen, it's vital that patients do not exceed their prescribed dosage without consulting with their healthcare provider.
At what dose is Bystolic typically prescribed?
Bystolic treatment is typically initiated at a dosage of 5 mg/day. The dose can then be increased to 10 mg/day depending on the patient's response and tolerance, taken once daily. For some patients, if no improvement in symptoms or blood pressure control are observed with the 10mg/day dose after several weeks, an adjustment to a maximum dose of 20-40 mg per day may be considered under careful medical supervision. Always remember that it's important for any changes in medication regimen to be made by your healthcare provider based on individual health needs and responses.
What are the most common side effects for Coreg?
Potential side effects of Bystolic and Coreg may include:
- Dizziness, lightheadedness, or feelings of fainting
- Slow heart rate (bradycardia)
- Fatigue or general weakness
- Headache
- Nausea and vomiting
- Diarrhea or constipation
- Insomnia or sleep disturbances
- Dry mouth
- Shortness of breath
- Decreased libido
- Swelling in the hands and feet (edema) from fluid retention.
These are not all the possible side effects. If you experience any unusual symptoms while taking these medications, please contact your healthcare provider immediately.
Are there any potential serious side effects for Coreg?
While rare, Coreg can cause adverse reactions such as:
- Shortness of breath or wheezing
- Symptoms of an allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing
- Unusually slow heartbeat and lightheadedness or fainting
- Severe liver disease symptoms including persistent nausea/vomiting, loss of appetite, stomach/abdominal pain, yellowing eyes/skin or dark urine.
Similarly with Bystolic:
- Signs of an allergic reaction: hives; difficult breathing; swelling in your face/lips/tongue/throat.
- Slow heart rate with dizziness and feeling like you might pass out;
- Sudden weight gain (more than 3 pounds in one day);
- Swollen ankles/feet/hands or gaining weight quickly; -Liver problems - upper stomach pain, itching, tired feeling, loss of appetite.
If you experience any serious side effects from either medication contact your healthcare provider immediately.
What are the most common side effects for Bystolic?
Taking Bystolic can lead to a variety of side effects, some of which include:
- Stuffy nose, sinus pain and sore throat
- Dizziness or lightheadedness due to low blood pressure
- Nausea, stomach upset or diarrhea
- Tiredness, insomnia or sleep problems
- Slower heart rate than normal
- Swelling in your legs or ankles (edema)
- Shortness of breath (especially during physical activity)
It's important to note that each individual may experience different side effects from medication based on their personal health conditions. Always consult with your healthcare professional before starting any new medication.
Are there any potential serious side effects for Bystolic?
While Bystolic is typically well-tolerated, it can occasionally produce severe side effects that require immediate attention. These may include:
- Signs of a strong allergic reaction such as hives, difficulty breathing or swallowing, facial swelling or throat tightness
- Unusual weight gain or fluid retention (swelling) in the hands and feet
- A slow heart rate (bradycardia) which might cause fatigue, dizziness or fainting
- Symptoms indicative of low blood sugar levels like confusion, sweating excessively, extreme hunger pangs and trembling
- Shortness of breath especially when lying down; difficulties with sleeping due to breathing problems
- Severe skin reactions including rashes that blister and peel.
If you experience any of these symptoms while taking Bystolic, seek medical help immediately.
Contraindications for Coreg and Bystolic?
Both Coreg and Bystolic, like most other beta-blocker medications, can worsen the symptoms of heart failure in some patients. If you notice an increase in your heart-related symptoms such as chest pain or discomfort, shortness of breath, fatigue or swelling in your legs or ankles while taking these drugs, please seek immediate medical attention.
Neither Coreg nor Bystolic should be taken if you are currently on certain types of medications including second-generation antipsychotic drugs due to their ability to further slow down the heart rate. Always inform your physician about any medications that you're currently taking; stopping these aforementioned medicines may require a gradual tapering process under medical supervision to prevent dangerous interactions with both Coreg and Bystolic.
How much do Coreg and Bystolic cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Coreg (carvedilol) at a common dose strength (25 mg) averages around $225, which works out to roughly $7.50 per day.
- The price for 30 tablets of Bystolic (nebivolol; 5 mg), on the other hand, is about $160, working out to approximately $5.33/day.
Thus, if you are prescribed a typical dosage range for these medications, then brand-name Bystolic tends to be less expensive on a per-day treatment basis. However, it's vital to remember that cost should not be your primary consideration in determining which of these drugs is right for you as both have different side effect profiles and drug interactions.
For the generic versions of Coreg (carvedilol) and Bystolic (nebivolol), costs significantly decrease:
- Carvedilol is available in packs starting from 30 up to several hundred tablets with approximate costs ranging from about $0.15 to $0.65 per day depending on the specific dosage prescribed.
- Generic nebivolol can cost between approximately $1 and $2 per tablet or between about $.90 and almost nearly over two dollars daily when considering more typical dosages like those seen in most prescriptions.
It's important also note that prices may vary based upon location, insurance coverage and pharmacy pricing disparities—thus it always pays off shopping around!
Popularity of Coreg and Bystolic
Carvedilol (brand name Coreg) and Nebivolol (brand name Bystolic), are both beta blockers that are often prescribed to manage conditions such as high blood pressure and heart failure.
In 2020, approximately 7.3 million people in the US were prescribed Carvedilol, making it a popular choice for managing cardiovascular conditions. It accounted for about 15% of all beta-blocker prescriptions last year.
On the other hand, Nebivolol was prescribed to roughly 2.8 million people in the same period in the USA. Despite its lesser popularity compared to Carvedilol, no significant differences have been found between these two drugs regarding their efficacy or safety profiles when treating hypertension or heart failure patients. However, Nebivolol is considered more cardioselective than Carvedilol which may lead some practitioners to prefer it for certain patient populations.
Conclusion
Both Coreg (carvedilol) and Bystolic (nebivolol) have well-established reputations for their effectiveness in managing hypertension, with numerous clinical studies supporting their efficacy over placebo treatments. In certain circumstances, these two drugs may be used together under the careful supervision of a physician as they can also interact negatively with each other. Their mechanisms of action differ slightly: carvedilol is a non-selective beta blocker and alpha-1 receptor blocker, while nebivolol is a selective beta 1-adrenergic receptor blocker.
Coreg has been around longer than Bystolic and is often considered first-line treatment for high blood pressure and heart failure due to its proven track record. Bystolic might be chosen by physicians when patients require an alternative to traditional beta blockers or exhibit specific contraindications.
Both drugs are available in generic form which represents substantial cost savings, especially beneficial for those who must pay out-of-pocket. Both Coreg and Bystolic might necessitate an adjustment period; hence effects might not be immediately noticeable.
The side effect profiles between the two medications are somewhat similar; both are generally well-tolerated but come with risks such as dizziness, fatigue or slow heartbeat among others. With any medication regimen involving these drugs, it's crucial that patients closely monitor their blood pressure readings and report any unusual symptoms promptly to their healthcare provider.
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Refrences
- Lombardo, R. M. R., Reina, C., Abrignani, M. G., Rizzo, P. A., Braschi, A., & De Castro, S. (2006). Effects of Nebivolol versus Carvedilol on Left Ventricular Function in Patients with Chronic Heart Failure and Reduced Left Ventricular Systolic Function. American Journal of Cardiovascular Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00129784-200606040-00006
- Feuerstein, G. Z., & Ruffolo, R. R. (1996, April 2). Carvedilol, a novel vasodilating beta-blocker with the potential for cardiovascular organ protection. European Heart Journal. Oxford University Press (OUP).http://doi.org/10.1093/eurheartj/17.suppl_b.24
- Kamp, O., Metra, M., Bugatti, S., Bettari, L., Dei Cas, A., Petrini, N., & Dei Cas, L. (2010, January). Nebivolol. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/11530710-000000000-00000
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- Ruffolo, R. R., & Feuerstein, G. Z. (2006, June). Carvedilol case history: the discovery and development of the first β-blocker for the treatment of congestive heart failure. Expert Opinion on Drug Discovery. Informa Healthcare.http://doi.org/10.1517/17460441.1.1.85
- Cheng, J. W. M. (2009, March). Nebivolol: A third-generation β-blocker for hypertension. Clinical Therapeutics. Elsevier BV.http://doi.org/10.1016/j.clinthera.2009.03.007
- Veverka, A., Nuzum, D. S., & Jolly, J. L. (2006, July). Nebivolol: A Third-Generation β-Adrenergic Blocker. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1345/aph.1g708
- Contini, M., Apostolo, A., Cattadori, G., Paolillo, S., Iorio, A., Bertella, E., … Agostoni, P. (2013, October). Multiparametric comparison of CARvedilol, vs. NEbivolol, vs. BIsoprolol in moderate heart failure: The CARNEBI trial. International Journal of Cardiology. Elsevier BV.http://doi.org/10.1016/j.ijcard.2013.01.277