Hey @teatime and everyone else on this thread. Because there were so many questions raised in this discussion about prescribing carvedilol and about weaning of the medication, I thought I'd involved one of our Mayo Clinic pharmacists. Here what she wrote:

"While carvedilol can be a very good medication for hypertension, it does have rare (0.1 to 1% of patients experiencing) side effects of abnormal thinking, aggravated depression, emotional instability, nervousness, and terrifying dreams. Unfortunately it sounds like you (@teatime) may be part of this subset of patients.

Carvedilol has a shorter half life than some of the other beta blockers which tends to make weaning off of it a little more difficult as the withdrawal side effects are more pronounced. A typical taper off of carvedilol would include taking the usual dose once a day for one week, then taking every other day for one week, then stopping. Some people will wean down more slowly or extend the taper if they are experiencing the withdrawal side effects. A longer form of the taper could be to take the usual dose daily for a week, then a half dose daily for a week, then a half dose every other day for a week, then stop.

The body’s adrenergic receptors are upregulated in response to a person taking a beta blocker, which is why it is important to taper off of the medication and allow those receptors time to adjust to not having that beta blocker circulating in the body. After stopping the medication it can take about a week or more for those receptors to go back to normal, so it is not uncommon to continue to notice some side effects even after stopping the medication completely.

For most people, the side effects from the medication or from weaning off the medication are tolerable, but the symptoms you describe seem severe. It is good that you are continuing to follow up with your health care team during this process so they can monitor your heart and blood pressure closely."

I hope this helps.