Document Detail


The role of carvedilol in the management of portal hypertension.
MedLine Citation:
PMID:  20093937     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Carvedilol is a potent noncardioselective beta-blocker, with weak vasodilating properties because of alpha 1 blockade. A reduction in both intrahepatic and portocollateral resistance contribute to enhanced effects on portal pressure. There are 10 published hemodynamic studies involving 168 patients investigating the role of carvedilol in portal hypertension. A reduction in the hepatic venous pressure gradient of up to 43% (range 10-43%) has been reported, particularly after chronic administration. However, tolerability at doses greater than 12.5 mg/day was comprised because of a fall in mean arterial pressure (MAP), particularly in ascitic patients. Carvedilol was more effective than propranolol in reducing hepatic venous pressure gradient in two of three studies, albeit with a greater decrease in MAP. One study showed deterioration of pre-existing ascites with carvedilol. The addition of nitrates to propranolol was less effective than carvedilol monotherapy in another study. A large multicentre, randomized controlled trial comparing carvedilol with variceal band ligation for the prevention of variceal bleeding has been published. Carvedilol resulted in fewer episodes of bleeding, although there was no difference in survival. Carvedilol was well tolerated. Carvedilol is a promising agent, and seems to be more effective than propranolol in hemodynamic studies. The efficacy in primary prevention of variceal bleeding suggests that carvedilol has a role in the management of clinically significant portal hypertension.
Authors:
Dhiraj Tripathi; Peter C Hayes
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  22     ISSN:  1473-5687     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-15     Completed Date:  2010-11-08     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  905-11     Citation Subset:  IM    
Affiliation:
Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK. d.tripathi@bham.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / adverse effects,  therapeutic use*
Ascites / drug therapy
Benzopyrans / adverse effects,  pharmacology,  therapeutic use
Carbazoles / adverse effects,  pharmacology,  therapeutic use*
Drug Therapy, Combination / adverse effects
Ethanolamines / adverse effects,  pharmacology,  therapeutic use
Hemodynamics / drug effects
Humans
Hypertension, Portal / drug therapy*
Multicenter Studies as Topic
Nitrates / therapeutic use
Propanolamines / adverse effects,  pharmacology,  therapeutic use*
Propranolol / adverse effects,  therapeutic use
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Benzopyrans; 0/Carbazoles; 0/Ethanolamines; 0/Nitrates; 0/Propanolamines; 030Y90569U/nebivolol; 0K47UL67F2/carvedilol; 525-66-6/Propranolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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