Octreotide enhances portal pressure reduction induced by propranolol in cirrhosis: a randomized, controlled trial.
BACKGROUND
In vitro, octreotide potentiates vasoconstriction in isolated, preconstricted, mesenteric arterial vessels. In cirrhotic patients, portal pressure (HVPG) reduction induced by propranolol is partly due to splanchnic vasoconstriction.


OBJECTIVE
To evaluate HVPG effects of octreotide administration in cirrhotic patients receiving long-term propranolol.


METHODS
A randomized, controlled trial. First study: a total of 28 patients were studied at baseline and 30 and 60 minutes after octreotide (200 mug) (N = 14) or placebo (N = 14) and then treated with propranolol for approximately 30 days (106 +/- 5 mg/day). Second study: after baseline evaluation patients received octreotide or placebo as they were assigned to in the first study and measurements repeated 30 and 60 minutes later.


RESULTS
In the first study baseline HVPG was 18.7 +/- 0.9 mmHg and decreased to 17.1 +/- 1.1 mmHg and 17.1 +/- 1.0 mmHg (both P < 0.05 vs baseline) at 30 and 60 minutes after octreotide, respectively. Eight patients decreased their HVPG after octreotide. In the second study baseline HVPG was 15.6 +/- 1.3 mmHg (P < 0.01 vs baseline HVPG in first study) and decreased to 14.1 +/- 1.2 mmHg and 14.1 +/- 1.3 mmHg (25.7 +/- 5% lower than baseline HVPG in the first study, P < 0.01) (both P < 0.05 vs baseline) at 30 and 60 minutes after octreotide, respectively. Nine patients (2 responders/7 nonresponders to propranolol) decreased their HVPG after octreotide. Octreotide effects may be mediated by potentiation and additive mechanisms.


CONCLUSIONS
Octreotide enhances HVPG reduction induced by propranolol in cirrhotic patients.
Vorobioff
Julio D
JD
Liver Unit and Hepatic Hemodynamic Laboratory, Sanatorio Parque, and Hospital Provincial del Centenario, Rosario, Argentina.
Ferretti
Sebastián E
SE
Zangroniz
Pedro
P
Gamen
Marcelo
M
Picabea
Eduardo
E
Bessone
Fernando O
FO
Reggiardo
Virginia
V
Diez
Ana R
AR
Tanno
Mario
M
Cuesta
Cristina
C
Tanno
Hugo E
HE
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology; D004334:Drug Administration Schedule; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000494:pharmacology*; D017082:Portal Pressure / Q000187:drug effects*; D011433:Propranolol / Q000008:administration & dosage / Q000494:pharmacology
D000319:Adrenergic beta-Antagonists; D005765:Gastrointestinal Agents; D011433:Propranolol; D015282:Octreotide