Comparative pilot study of repeated large volume paracentesis vs the combination on clonidine-spironolactone in the treatment of cirrhosis-associated refractory ascites

Ascites and spontaneous bacterial peritonitis: An Asian perspective

“…In a small randomised study comparing the usefulness of clonidine plus spironolactone to that of LVP, clonidine induced neurohormonal changes and significantly decreased the frequency of and time to rehospitalisation. 45 Moreover, in a subsequent study, the administration of clonidine plus spironolactone induced an earlier diuretic response with reduced diuretic drug requirements and side effects. 46 Likewise, midodrine, an a-1 adrenergic agonist, was studied for a 7-day treatment period, and was found to improve systemic hemodynamics and urinary sodium excretion, although no effect on ascites was described.…”

“…Clonidine is a centrally acting α2‐agonist and has been investigated because splanchnic arterial vasodilatation with subsequent reduction in effective blood volume is associated with the pathogenesis of ascites. In a small randomised study comparing the usefulness of clonidine plus spironolactone to that of LVP, clonidine induced neurohormonal changes and significantly decreased the frequency of and time to rehospitalisation 45 . Moreover, in a subsequent study, the administration of clonidine plus spironolactone induced an earlier diuretic response with reduced diuretic drug requirements and side effects 46 .…”

Management of adult patients with ascites due to cirrhosis

“…A pilot randomized trial of 0.075 mg of oral clonidine twice per day versus placebo in patients with cirrhosis, ascites, and a plasma norepinephrine level of >300 pg/mL demonstrated more rapid mobilization of ascites with fewer complications 116. Another pilot randomized trial of paracentesis plus albumin versus clonidine plus spironolactone in patients with cirrhosis, refractory ascites, and a plasma norepinephrine level of >300 pg/mL demonstrated fewer hospitalizations in the latter group 117. A pilot study of subcutaneous octreotide in two patients with refractory ascites demonstrated an improvement in renal function and hemodynamics and a reduction in renin and aldosterone 118.…”

Association of the G-protein and 2-adrenergic receptor gene and plasma norepinephrine level with clonidine improvement of the effects of diuretics in patients with cirrhosis with refractory ascites: a randomised clinical trial

“…Studies in patients with cirrhosis8 9 reported that genetic polymorphisms of the β-adrenoceptor and angiotensin II type 1 receptor (AT1R) significantly affect the drug response to β- and AT1R-blockers 10 11. Thus, we hypothesised that ADRA 2 gene polymorphisms may affect the clonidine drug response in cirrhosis.…”