The calcium‐channel blocker, verapamil, does not improve portal pressure in patients with alcoholic cirrhosis.

Abstract

1. Recently the calcium‐channel blocker, verapamil, has been reported to decrease portal pressure in rats with experimental cirrhosis and in patients with liver cirrhosis. 2. In eight patients with alcoholic cirrhosis the effect of verapamil (5 mg i.v.) on systemic and splanchnic haemodynamics was investigated. 3. Mean arterial pressure, wedged hepatic venous pressure, hepatic venous pressure gradient, and verapamil plasma concentrations were measured before and at 10, 20, 30 min following 5 mg i.v. administration of verapamil. At 30‐40 min cardiac output, systemic vascular resistance and hepatic blood flow were also measured. 4. Verapamil plasma concentrations averaged 47.9 +/− 52.0, 36.5 +/− 36.3, 31.3 +/− 33.9 ng ml‐1 at 10, 20, 30 min respectively: mean arterial pressure and systemic vascular resistance decreased significantly (‐9% and −14% respectively), and cardiac index increased significantly (+8%). Wedged hepatic venous pressure and hepatic venous pressure gradient remained unchanged, variations never exceeding 0.2 kPa. Hepatic blood flow increased significantly by 12%. 5. These results show that i.v. administration of 5 mg verapamil does not decrease portal pressure in alcoholic cirrhosis. This lack of effect is probably the consequence of a balance between decrease in porto‐hepatic vascular resistance and increase in splanchnic blood inflow.

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

“…Thus, Miotti & Reichen (1985) found a decrease in the elimination rate constant of ICG after verapamil. However, the use of the elimination rate constant of ICG as an estimate of liver function may lead to errors due to variations in volume of distribution or in liver blood flow (Keiding, 1987), as might occur after verapamil administration (Lay et al, 1988;Merkel et al, 1988). Kong et al (1986) observed an increase in serum albumin levels after 3 months of verapamil administration.…”