Carvedilol for Facial Flushing
Carvedilol is a beta-blocker that was developed to treat high blood pressure and heart failure. In dermatology it is used off-license to control severe facial flushing, most often in patients whose rosacea presents predominantly as flushing rather than as fixed redness or inflammatory spots. "Off-license" (or "off-label") means the drug is being prescribed for a purpose other than the one it was formally licensed for. This is a common and legitimate practice in medicine, but it does mean the decision to prescribe rests on clinical judgement and the balance of benefit and risk in your particular case.
I consider carvedilol for patients whose flushing is severe enough to interfere with work or social life, and where topical treatments and trigger avoidance have not been sufficient.
How it works
Flushing occurs when the small blood vessels of the face dilate rapidly, often in response to adrenaline released during stress or emotional situations. Carvedilol blocks the effect of adrenaline on these vessels, reducing the speed and intensity of that response. Compared with propranolol, carvedilol is often better tolerated and has a longer duration of action, which is why I frequently prefer it.
Who should not take carvedilol
Carvedilol is not suitable for everyone. You should not take carvedilol if you have asthma, low blood pressure, a slow heart rate, heart block, heart failure, or other cardiac conditions. If you have any history of heart or lung disease, tell me before we consider this treatment. If you have diabetes, carvedilol requires particular care because it can alter blood-glucose control and can mask some of the warning symptoms of a low blood sugar.
Dosing
Carvedilol is usually started at a dose of 6.25mg once daily. If it is tolerated, the dose can be increased gradually. Starting low and increasing slowly reduces the chance of dizziness and light-headedness, which are most likely in the first days of treatment and after each dose increase.
Possible side effects
As with any medication, carvedilol can cause side effects. These include:
- Dizziness or light-headedness, particularly on standing
- Fatigue
- Headache
- Low blood pressure
- A slow pulse
- Fainting
- Cold hands or feet
- Nausea, vomiting or diarrhoea
- Sleep disturbance
- Wheezing or breathlessness
- Fluid retention
- Worsening heart failure
- Altered blood-glucose control in patients with diabetes
Effects on exercise
Carvedilol may reduce exercise tolerance or make exercise feel more difficult. This happens because the drug blunts the normal rise in heart rate that your body uses to meet the demands of exertion. If you train seriously or your work is physically demanding, this is worth weighing carefully before starting treatment, and it is worth telling me so that we can factor it into the decision.
When to stop and seek medical advice
Stop taking carvedilol immediately and seek medical advice if you experience a marked or persistent reduction in exercise capacity, chest pain, fainting, or significant breathlessness. These symptoms may indicate that the medication is affecting your heart or lungs and they should not be ignored or "pushed through".
Before you start
It is essential that you read the manufacturer's patient information leaflet in full before starting treatment. The leaflet supplied with the packaging contains critical safety information and the complete list of recognised side effects, and it is more comprehensive than any summary I can give here.
Related articles
- Medications for Facial Flushing (Clonidine, Propranolol, Carvedilol)
- Side Effects of Flushing Medications
- Stress and Emotional Flushing
- Exercise Without Flushing
