Effect of acute administration of propranolol, carvedilol, iso-sorbide dinitrate, “propranolol plus iso-sorbide dinitrate” and “carvedilol plus iso-sorbide dinitrate” on portal venus pressure.

Abstract

Pharmacotherapy of portal hypertension in patients with cirrhosis includes beta-blockers, nitrates, somatastain analogues, alpha-blockers like prazocin.   These drugs differ widely in their effectiveness, adverse effects and patient compliance.  Beta-blockers particularly propranolol are the most commonly used drugs.  Of late, carvedilol has been used and found to be superior to propranolol.  The present study was aimed at assessing the effect of propranolol, carvedilol, iso-sorbide dinitrate; combination of “propranolol and iso-sorbide-dinitrate” and carvedilol and isosorbide dinitrate” on portal venous pressure in cirrhosis of liver.  40 consecutive patients with cirrhosis were subjected to hepatic venous catheterization.  Baseline free and wedged hepatic venous pressures were recorded.  Patients were randomly assigned to receive propranolol.  40 mgm PO (n=8); carvedilol 25mg PO (n=8); iso-sorbide dinitrate 20 mg PO (n-8); propranol plus iso-sorbide dinitrate (40 mg and 20 mg) (n=8) and carvedilol plus iso-sorbide dinitrate (25 mg and 20 mg PO)  (n=8).  Hemodynamic values were repeated 90 minutes after drug administration.  All drugs significantly decreased the hepatic venous pressure gradient.  Combination of carvedilol and iso-sorbide dinitrate was found to be most effective.  The mean ± SD drop in hepatic venous pressure gradient was: propranolol 4.3 ± 1.4 mmHg (27%); Carvedilol 4.4 ± 1.8 mmHg (30%); iso-sorbide dinitrate 2.8 ± 1.4 mmHg (17%); propranolol plus iso-sorbide dinitrate” 5.1 ± 1.0 mmHg (31%) and “Carvedilol plus iso-sorbide dinitrate” 5.5 ± 1.2 mmHg (36%).  Conclusion: combination of carvedilol and iso-sorbide dinitrate is the most effective anti-portal hypertensive regimen in patients of cirrhosis. JMS 2013;16(2):80-85