Skip to content
Research Article Open access CC BY 4.0

A Haemodynamic Analysis to Assess the Safe Dose of Carvedilol across Different Child Class of Liver Disease

Zeeshan Ahmad Wani, Riyaz Ahmad Bhat, Ajeet Singh Bhadoria, Showkat Ali Zargar, Altaf Hussain Shah, Rakhi Maiwall, Iqra Hameed, Syed Basit

Journal of Advances in Medicine and Medical Research · pp. 355–368 · Published 26 Feb 2015

10.9734/BJMMR/2015/15398

Abstract

Background: Literature regarding safe dose of carvedilol is limited and also safe dose across different child classes of chronic liver disease is not very clear. Aim: We aimed primarily to study, the effect of reasonably safe dose (12.5 mg) of carvedilol in acute reduction of portal pressure and compared it with chronic reduction of portal pressure, after proper optimization of dose of carvedilol. Second aim of our study was to define predictors of response for acute and chronic reduction of portal pressure and to assess difference in dose tolerated and response across different child class on chronic basis. Methods: One hundred two consecutive patients of cirrhosis of liver with significant portal hypertension were included and hepatic venous pressure gradient was measured at the base line and after 90 minutes of administration of 12.5 mg carvedilol. After proper dose optimization of carvedilol, hepatic venous pressure gradient was again measured after 3 months to assess the chronic response. Results: The mean age of study population was 58.3±6.6 years. A total of 42.2%, 31.9% and 26.6% patients had child class A, child class B and Child class C cirrhosis, respectively. Mean pre-drug hepatic venous pressure gradient was 16.75±2.12 mmHg which dropped to 13.07±2.32 mmHg after 90 minutes of administration of 12.5 mg of carvedilol. The mean drop of hepatic venous pressure gradient was 4.5±2.2 mmHg and 2.4±1.9 mmHg among responders and non-responders, respectively. Overall, 51% showed acute response while 49% were non-responders. Low cardiac output and high mean arterial pressure were significantly predicting the acute response, while, low baseline cardiac output was found as an independent predictor. After dose optimization, number of responders increased from 52 to 62. Mean dose of carvedilol was higher in non–responders as compared to responders, though statistically insignificant (p>0.05). Mean reduction of hepatic venous pressure gradient from baseline and after 3 months was 5.5±1.7 mmHg and 2.8±1.6 mmHg among responders and non responders on chronic basis, respectively (p<0.001). Absence of any adverse events (OR 11.3, 95% CI; 1.9-67.8), and more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response (OR 8.7, 95% CI; 3.1-25.3) were found as independent predictors of chronic response (p<0.05). Univariate analysis found that no adverse events, no ascites, low baseline cardiac output, more than 2.5 mmHg fall in hepatic venous pressure gradient during acute response, as predictors of chronic response. However, etiology, child class, variceal size (large vs small) and gender were not significantly associated with chronic response Conclusion: At safe dose and with proper optimization of dose, carvedilol may achieve greater response with minimum side effects among different child classes of liver disease.

Carvedilol hepatic venous pressure gradient portal hypertension.

References (33)

  1. 1 Hepatic Venous Pressure Gradient Predicts Clinical Decompensation in Patients With Compensated Cirrhosis [DOI]
  2. 2 Management of Varices and Variceal Hemorrhage in Cirrhosis [DOI]
  3. 3 Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage [DOI]
  4. 4 Hemodynamic Response to Pharmacological Treatment of Portal Hypertension and Long–Term Prognosis of Cirrhosis [DOI]
  5. 5 Simvastatin Lowers Portal Pressure in Patients With Cirrhosis and Portal Hypertension: A Randomized Controlled Trial [DOI]
  6. 6 Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol [DOI]
  7. 7 Current management of portal hypertension [DOI]
  8. 8 The management of portal hypertension: Rational basis, available treatments and future options [DOI]
  9. 9 Pharmacology of carvedilol [DOI]
  10. 10 Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed # † [DOI]
  11. 11 Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis [DOI]
  12. 12 Measurement of Portal Pressure and Its Role in the Management of Chronic Liver Disease [DOI]
  13. 13 Banding Ligation Versus Beta-Blockers as Primary Prophylaxis in Esophageal Varices: Systematic Review of Randomized Trials [DOI]
  14. 14 New therapeutic paradigm for patients with cirrhosis [DOI]
  15. 15 Meta-analysis of value of propranolol in prevention of variceal haemorrhage [DOI]
  16. 16 “A La Carte” treatment of portal hypertension: Adapting medical therapy to hemodynamic response for the prevention of bleeding [DOI]
  17. 17 Carvedilol, a new nonselective beta-blocker with intrinsic anti-alpha1-adrenergic activity, has a greater portal hypotensive effect than propranolol in patients with cirrhosis [DOI]
  18. 18 Value of the Hepatic Venous Pressure Gradient to Monitor Drug Therapy for Portal Hypertension: A Meta-Analysis [DOI]
  19. 19 Carvedilol for Portal Hypertension in Patients With Cirrhosis [DOI]
  20. 20 Acute Administration of Carvedilol is More Effective than Propranolol Plus Isosorbide-5-Mononitrate in the Reduction of Portal Pressure in Patients with Viral Cirrhosis [DOI]
  21. 21 Acute and 7‐day portal pressure response to carvedilol and propranolol in cirrhotics [DOI]
  22. 22 Meta analysis of propranolol effects on gastrointestinal hemorrhage in cirrhotic patients [DOI]
  23. 23 Haemodynamic effects of acute and chronic administration of low‐dose carvedilol, a vasodilating β‐blocker, in patients with cirrhosis and portal hypertension [DOI]
  24. 24 Acute and chronic haemodynamic and renal effects of carvedilol in patients with cirrhosis [DOI]
  25. 25 Acute haemodynamic changes after oral carvedilol, a vasolidating beta-blocker, in patients with cirrhosis [DOI]
  26. 26 Variceal band ligation versus beta-blockers for primary prevention of variceal bleeding: a meta-analysis [DOI]
  27. 27 Evaluation of Carvedilol for the Treatment of Portal Hypertension [DOI]
  28. 28 Effect of carvedilol on portal hypertension depends on the degree of endothelial activation and inflammatory changes [DOI]
  29. 29 Carvedilol in the treatment of portal hypertension [DOI]
  30. 30 Acute and 14-Day Hepatic Venous Pressure Gradient Response to Carvedilol and Nebivolol in Patients With Liver Cirrhosis [DOI]
  31. 31 Effects of the alpha-/beta-blocking agent carvedilol on hepatic and systemic hemodynamics in patients with cirrhosis and portal hypertension.
  32. 32 Applicability of liver transplantation in Catalonia at the end of the millennium. A prospective study of adult patient selection for liver transplantation [DOI]
  33. 33 226 ACUTE AND 14-DAYS HEPATIC VENOUS PRESSURE GRADIENT RESPONSE TO CARVEDILOL AND NEBIVOLOL IN PATIENTS WITH LIVER CIRRHOSIS. A PILOT STUDY [DOI]

Cited by 4

Addition of simvastatin to carvedilol non responders: A new pharmacological therapy for treatment of portal hypertension

Zeeshan Ahmad Wani, Sonmoon Mohapatra, Afaq Ahmad Khan · World Journal of Hepatology · 2017

A Hemodynamic Study to assess response, tolerance and dose optimization of Carvedilol in Child Class A patients with Portal Hypertension

Shaheen Nazir, Zeeshan Ahmed, Muzzafer Mohamad · Asian Journal of Medical Sciences · 2021

Showing 2 of 4 known citations — external sources report more than can currently be individually listed.

Related research

Article metrics

Real usage data collected on this platform.

56

Page views

0

PDF downloads

26

Outbound clicks

4

Citations

Views over time

Views by country

Approximate, from request IP at view time — not citizenship or institution. Countries with fewer than 5 views are grouped as "Other".

Traffic sources

Referring site, by host.

Views and downloads exclude known bots/crawlers. Citations combines this platform's own DOI-resolved index with each external source's own reported total — see Cited by above for individually listed citing works. Last refreshed 0 seconds ago.