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

Abstract

1. Vasodilators are currently under investigation as possible therapeutic agents in the treatment of portal hypertension. Among them calcium‐channel antagonists and organic nitrates have been of particular interest. Few and conflicting data, however, have been reported on their effect on liver function. 2. Twenty patients with biopsy‐proven alcoholic cirrhosis were studied before and 25‐35 min following the acute administration of 5 mg verapamil i.v. (eight patients) or 5 mg isosorbide dinitrate sublingually (12 patients). The plasma clearance of indocyanine green (ICG) and its intrinsic hepatic clearance were used as indices of liver function. Seven further patients were investigated before and after a placebo infusion according to the same methodology. 3. No significant change in ICG kinetics was found after verapamil or isosorbide dinitrate.

Hepatic Elimination of Indocyanine Green with Special Reference to Distribution Kinetics and the Influence of Plasma Protein Binding

“…3.4) was calculated before and after an intervention such as injection of triglycyl-lysin-vasopressin (Merkel et ul. 1992), verapamil (Merkel et a/. 1990) or isosorbide dinitrate (Merkel er a/.…”

Plasma elimination of indocyanine green in the intact pig after bolus injection and during constant infusion: Comparison of spectrophotometry and high-pressure liquid chromatography for concentration analysis,

“…Indocyanine green (ICG) is an organic anion that is reported to be virtually nontoxic (1-31, distributed only in the plasma (4,5) and excreted exclusively by the liver (1). For these reasons it has been used for the study of liver function by analysis of its plasma decay after bolus injection (6-16) or its steady-state clearance during long-term infusion (17)(18)(19)(20)(21)(22)(23)(24). In addition, Fick's principle permits estimation of liver plasma flow rate from measurement of the concentration of ICG in a peripheral artery and a hepatic vein during steady-state infusion (18, 25).…”

Effects of alcohol on liver haemodynamics in the presence and absence of liver disease

“…The same has been observed following the administration of the antiserotonin drugs, ketanserin and ritan~erin.~""-"~ Plasma methionine encephalin has been shown to be increased in patients with oesophageal varices, compared with patients without ~arices.~"" There is also evidence, although somewhat controversial, showing that calcium channel blocker drugs such as verapamil can reduce hepatic resistance to portal blood flow and improve the clearance of indocyanine green by the liver. [345][346][347][348][349][350] The fact that functional factors, amenable to modification by medical interventions, can play an important role in determining portal hypertension opens the possibility of a medical treatment of one of the most serious consequences of alcoholic liver disease.…”