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Nadolol plus Spironolactone Reduces Complications in Cirrhotic Patients
A DGReview of :"Nadolol plus spironolactone in the prophylaxis of first variceal bleed in nonascitic cirrhotic patients: A preliminary study."
Hepatology
02/06/2003
By David Loshak
The combined use of nadolol and spironolactone in patients with liver cirrhosis reduces the incidence of the two portal-hypertensive complications, bleeding and ascites, together.
Adding spironolactone to nadolol, however, does not increase the efficacy of nadolol alone in preventing the first variceal bleeding, report gastroenterological specialists in Buenos Aires, Argentina.
They pointed out that treatment with beta-blockers did not lower portal pressure in nearly 40% of cirrhotic patients. Also, recent studies had suggested that spironolactone reduced pressure and flow in the portal and variceal systems.
The specialists, therefore, looked into whether nadolol plus spironolactone was more effective than nadolol alone in preventing the first variceal bleeding.
In a multi-centre, double-blind, trial, the specialists randomised 100 patients with medium and large varices who had never bled and were without ascites to receive nadolol plus placebo or nadolol plus spironolactone 100 mg. daily.
Hepatic venous pressure gradient and the activity of the renin-aldosterone system were measured in 24 of the patients.
At a mean follow-up of 22±16 months, there were no significant differences between the two patient groups in the appearance of variceal bleeding and ascites. But, the incidence of the two complications considered together was almost twice as high (39%) in the 51 patients given nadolol plus placebo than in the 49 who received nadolol plus spironolactone (20%).
Clinical ascites was also significantly higher in patients in the placebo group (21%) than in the spironolactone group (6%). In addition, in the spironolactone group only, the researchers observed significant increases in plasma renin activity and plasma aldosterone levels.
The cumulative probabilities of remaining free of bleeding and ascites were similar in both groups after 70 months of follow-up.
Hepatology 2003;37:2:359-365.
"Nadolol plus spironolactone in the prophylaxis of first variceal bleed in nonascitic cirrhotic patients: A preliminary study."
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