Effect of nadolol on liver haemodynamics and function in patients with cirrhosis.

Abstract

P-adrenoceptor blockers used in the medical management of portal hypertension decrease liver blood flow. The sporadic onset of hepatic encephalopathy during propranolol treatment was ascribed to this decrease. The aim of the present study was to evaluate the effect of chronic treatment with nadolol on liver blood flow and liver function. Nadolol, a non-cardioselective P-adrenoceptor blocker, has been reported to be as powerful as propranolol in decreasing portal pressure. Before and after 1 month of treatment with nadolol at a dose reducing heart rate by 25%, in 15 cirrhotic patients with portal hypertension, the following parameters were determined: hepatic venous pressure gradient, hepatic blood flow, galactose eliminating capacity, aminopyrine metabolic activity, ICG clearance and intrinsic hepatic clearance. Hepatic venous pressure gradient and hepatic blood flow were decreased by nadolol. However liver function was not affected by the drug. We conclude that, despite a lowered hepatic blood flow, liver function is not affected by 1 month of nadolol treatment.

Nadolol for Prevention of Variceal Rebleeding in Cirrhosis: A Controlled Clinical Trial

“…Furthermore, in spite of a decrease in hepatic blood flow, we pre viously demonstrated [22] that nadolol does not depress hepatic function as evaluated using quantitative techniques such as galac tose and aminopyrine tests. Renal hemody namics and function were also found unaf fected: in fact, after 1 month of treatment we observed an increase in the fraction of car diac output distributed to the kidneys and an increase, although not significant, in glomer ular filtration rate [3], Such an effect is very important in cirrhotics, since they often show impaired renal hemodynamics and function [23,24], Moreover, nadolol scarcely crosses the blood-brain barrier due to its low lipid solubility [13], This is rele vant, since the onset of encephalopathy re ported in patients receiving propranolol could likely be due more to the interference of the drug with brain metabolism of sero tonin [25] or to the direct effect on the cen tral nervous system than to a decrease in hepatic blood flow [22], Lastly, nadolol has a long serum half-life [13]: this allows a single daily administration and a good patient compliance can be expected. In fact, our patients receiving nadolol demonstrated a good compliance to treatment, as shown by the persistent decrease in heart rate.…”

Evaluation of regional hepatic perfusion (RHP) by contrast-enhanced ultrasound in patients with cirrhosis

“…The absence of a fully statistically significant result might be due to the small number of patients studied, but also to the well established effects of beta-blockers, which reduce the splanchnic blood flow but not the hepatic blood flow due to a concomitant ''buffer'' response of an increased hepatic artery blood flow, which has been shown both in animal models and patients with cirrhosis [41][42][43].…”

Lack of effect of verapamil and isosorbide dinitrate on the hepatic clearance of indocyanine green in cirrhosis.

“…A constant i.v. infusion of ICG was administered as described by Merkel et al (1986). Briefly, following an i.v.…”