title: After proper optimization of carvedilol dose, do different child classes of liver disease differ in terms of dose tolerance and response on a chronic basis?
abstract: OBJECTIVE
  Literature regarding safe doses of carvedilol is limited, and safe doses across different Child classes of chronic liver disease are not clear.
  
  
  METHODS
  A total of 102 consecutive cirrhotic patients with significant portal hypertension were included in this study. Hepatic venous pressure gradient was measured at baseline and 3 months after dose optimization.
  
  
  RESULTS
  A total of 102 patients (63 males, 39 females) with a mean age of 58.3 ± 6.6 years were included. Among these patients, 42.2% had Child Class A, 31.9% had Class B, and 26.6% had Child Class C liver disease. The mean baseline hepatic venous pressure gradient was 16.75 ± 2.12 mmHg, and after dose optimization and reassessment of hepatic venous pressure gradient at 3 months, the mean reduction in the hepatic venous pressure gradient was 5.5 ± 1.7 mmHg and 2.8 ± 1.6 mmHg among responders and nonresponders respectively. The mean dose of carvedilol was higher in nonresponders (19.2 ± 5.7 mg) than responders (18.75 ± 5.1 mg). However, this difference was not statistically significant (P > 0.05). The univariate analysis determined that the absence of adverse events, the absence of ascites, and low baseline cardiac output were significantly associated with chronic response, whereas, the etiology, Child class, variceal size (large vs small), and gender were not. On multivariate analysis, the absence of any adverse event was determined to be an independent predictor of chronic response (OR 11.3, 95% CI; 1.9-67.8).
  
  
  CONCLUSIONS
  The proper optimization of the dose of carvedilol, when administered chronically, may enable carvedilol treatment to achieve a greater response with minimum side effects among different Child classes of liver disease.
authors.forename: Zeeshan A
authors.initials: ZA
authors.lastname: Wani
authors.affiliation: Department of Internal Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: Riyaz A
authors.initials: RA
authors.lastname: Baht
authors.forename: Ajeet S
authors.initials: AS
authors.lastname: Bhadoria
authors.forename: Rakhi
authors.initials: R
authors.lastname: Maiwall
authors.forename: Yamin
authors.initials: Y
authors.lastname: Majeed
authors.forename: Afaq A
authors.initials: AA
authors.lastname: Khan
authors.forename: Showkat A
authors.initials: SA
authors.lastname: Zargar
authors.forename: Mohd A
authors.initials: MA
authors.lastname: Shah
authors.forename: Kaiser M
authors.initials: KM
authors.lastname: Khan
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002227:Carbazoles / Q000008:administration & dosage* / Q000009:adverse effects*; D000077261:Carvedilol; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects; D011412:Propanolamines / Q000008:administration & dosage* / Q000009:adverse effects*; D011446:Prospective Studies; D016896:Treatment Outcome; D014648:Varicose Veins / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol