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

Abstract

Nadolol, a nonselective beta-blocker, has been shown to decrease portal pressure in patients with cirrhosis at the same degree as propranolol. No data are available, however, about its effect on rebleeding rate and mortality in patients undergoing prevention of rebleeding from esophageal varices. A prospective randomized clinical trial was performed in patients with cirrhosis who survived a documented episode of variceal hemorrhage. 12 patients received nadolol, 12 placebo. Patients with child’s C grade, tense ascites, renal failure, contraindications to beta-blocker, or age > 70 were not included. After a follow-up of up to 145 weeks, 9 patients in the nadolol group and 4 in the placebo group survived free from rebleeding (log-rank test: χ² = 4.35, p < 0.05). Survival was not statistically different in the two groups (1 death in the nadolol group, 3 in the placebo group). In conclusion, nadolol appears to represent an effective therapy in the prevention of variceal rebleeding in cirrhotic patients.

β-blockade prevents recurrent gastrointestinal bleeding in well-compensated patients with alcoholic cirrhosis: A multicenter randomized controlled trial

“…Atenolol was given in a single fixed dose, whereas propranolol was adjusted according to the response of the pulse rate. When one compares our results with those of Gatta et al (21) with nadolol, the rates of rebleeding of our patients on propranolol and of Gatta's patients on nadolol (24% and 25%) are very similar. On the other hand, the incidences of side effects in our patients on atenolol (12%) and in Gatta's patients on nadolol (8%) are also very similar.…”

“…It is not metabolized by the liver, has low affinity for plasma proteins, is water soluble and can be given on a once-a-day schedule (18-20). Nadolol, a nonselective 8-blocker with pharmacokinetic properties similar to those of atenolol, has been shown to prevent rebleeding effectively in well-compensated cirrhotic patients (21).…”

UK guidelines on the management of variceal haemorrhage in cirrhotic patients

“…A total of 755 patients were randomised in 11 trials comparing propranolol or nadolol134 with no active treatment 2930-33 49 134-138 Significant reduction in rebleeding was seen in four trials and a meta-analysis showed significant overall reduction (OR 0.4, 95% CI 0.3–0.54).…”

The treatment of portal hypertension: A meta-analytic review

“…172,[175][176][177]181 Rebleeding was reduced by P-blockers in all trials, significantly in 4. 172,175,178,180 The pooled estimate shows a clear reduction of rebleeding (POR, 0.40, CI, 0.30 to 0.54). Death risk was reduced with P-blockers in 8 trials and unchanged or nonsignificantly increased in 3.173,174,181 One study'" did not report mortality.…”