title: Randomised controlled double-blind trial of the calcium channel antagonist amlodipine in the treatment of acute alcoholic hepatitis.
abstract: OBJECTIVE
  Calcium channel blockers have a hepatoprotective action in animal models of alcohol-induced liver injury but their effect in alcoholic liver disease in humans has not been previously investigated. We have conducted a randomised, placebo-controlled trial to investigate the possible benefit of the calcium channel blocker amlodipine in terms of 4-week survival in hospitalised patients with severe acute alcoholic hepatitis.
  
  
  METHODS
  Sixty-two patients with acute alcoholic hepatitis were randomised to receive 5-10 mg amlodipine each day for 1 year or an identical capsule containing placebo. In 36 (58%), acute alcoholic hepatitis was confirmed on biopsy and in the remainder on clinical and laboratory criteria. There were no statistically significant differences in clinical characteristics and disease severity in the treated and placebo groups.
  
  
  RESULTS
  Of the 32 patients receiving amlodipine, there were six deaths (19%) in the first 4 weeks compared with seven (23%) of the placebo patients (p=0.329). Causes of death were similar in the amlodipine and control groups, with liver failure predominant. Analysis by the Cox proportional hazards model after adjustment for other prognostic factors showed survival was not significantly influenced by active treatment (p=0.07). One patient in each group was withdrawn because of the development of hypotension, but this did not recur on reintroduction of the capsules.
  
  
  CONCLUSIONS
  This study shows that calcium channel blockers are well tolerated with few side effects in advanced alcoholic liver disease, but there is no conclusive evidence from this study that calcium channel blockers are helpful in the treatment of alcoholic hepatitis.
authors.affiliation: Department of Medicine, Stobhill General Hospital, Glasgow, UK.
authors.forename: G L
authors.initials: GL
authors.lastname: Bird
authors.forename: A T
authors.initials: AT
authors.lastname: Prach
authors.forename: A D
authors.initials: AD
authors.lastname: McMahon
authors.forename: J A
authors.initials: JA
authors.lastname: Forrest
authors.forename: P R
authors.initials: PR
authors.lastname: Mills
authors.forename: B J
authors.initials: BJ
authors.lastname: Danesh
mesh_terms: D000208:Acute Disease; D017311:Amlodipine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001682:Biological Availability; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D006801:Humans; D017093:Liver Failure / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate
chemical_list: D002121:Calcium Channel Blockers; D017311:Amlodipine