Symptoms resolved when doses of carvedilol and captopril were separated by 2 hours. Prior dosing schedule of carvedilol and captopril was resumed after two days. The remainder of the up titration period was without incident. No medical contraindications are present. The patient has compensated heart failure.
Medical therapy is optimized.
Initiation of carvedilol is reasonable. Carvedilol was initiated at 3.125 mg bid and was tolerated well. At the return clinic visit 2 weeks later, moderate lightheadedness was seen 2 hours after the first dose of 6.25 mg was given. Symptoms and BP improved after an additional 60 minutes. A decision is required on further carvedilol dosing.