Effect of long-term therapy with nipradilol on esophageal varices in patients with compensated cirrhosis. Results of a multicenter open study.
The effect of long-term administration of nipradilol (NIP, Hypadil Kowa, CAS 81486-22-8), a beta-blocker with a vasodilatory action, on esophageal varices was studied in 66 patients with compensated liver cirrhosis. Administration of NIP (6-12 mg/d) for 3-12 months produced progressive improvement of endoscopic findings over time (30% for C, 25% for F, and 40% for the R-C sign after 12 months). At the last examination (mean: 9 +/- 4 months), the improvement rates were 16.7%, 16.7% and 22.7%, respectively. No significant relationship was found between endoscopic improvement and the Child-Pugh score or the dose of NIP. Gastrointestinal bleeding occurred in five patients: one had bleeding esophageal varices, three had bleeding gastric varices, and one had a bleeding gastric ulcer. The systolic blood pressure was decreased significantly (4.6-12.3%) at 2 weeks as well as 1 and 2 months, and the heart rate showed a significant decrease throughout the study (10-18.4%). With the exception of the patients who had gastrointestinal bleeding, no symptoms of decompensation appeared, and there was no deterioration of laboratory parameters including ammonia. Adverse effects occurred in about 10% of the patients, most of which were related to bradycardia and/or hypotension, and they improved when the drug was withdrawn or the dose reduced. These results suggest that long-term administration of NIP is useful in the treatment of esophageal varices.
First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
H
H
Okumura
T
T
Aoyagi
K
K
Iwamura
H
H
Obata
S
S
Harada
T
T
Aramaki
Y
Y
Katsuta
S
S
Saito
W
W
Ohta
H
H
Okuda
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000473:pathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
D011412:Propanolamines; D014665:Vasodilator Agents; C036089:nipradilol