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Propranolol in chronic liver disease: a controlled trial of its effect and safety over twelve months
P C Hayes1, S Crichton, A N Shepherd
1University Department of Medicine, Ninewells Hospital and Medical School, Dundee.
Insights
Propranolol (Inderal-LA) is safe for long-term use in chronic liver disease patients. While it did not worsen liver function, further studies are needed to confirm its benefits for portal hypertension.
Area of Science:
- Hepatology
- Clinical Pharmacology
Background:
- Chronic liver disease poses significant health risks, including upper gastrointestinal bleeding and potential complications from portal hypertension.
- Propranolol is a beta-blocker often considered for managing conditions associated with liver disease.
Purpose of the Study:
- To evaluate the safety and efficacy of long-term propranolol treatment in patients with mild to moderate chronic liver disease.
- To assess the impact of propranolol on clinical condition, liver function tests, and serum testosterone levels.
Main Methods:
- A 12-month, double-blind, placebo-controlled trial involving 95 patients with chronic liver disease.
- Patients received either propranolol (Inderal-LA) or a placebo.
- Outcomes measured included mortality, upper gastrointestinal bleeding, patient withdrawal, clinical status, liver function tests, and serum testosterone levels.
Main Results:
- Propranolol treatment was associated with lower mortality (3 vs. 8 deaths) and no upper gastrointestinal bleeding compared to placebo.
- No deterioration in clinical condition or liver function tests was observed in the propranolol group.
- Serum testosterone levels significantly decreased in the propranolol group compared to controls.
Conclusions:
- Long-term propranolol treatment appears safe for patients with chronic liver disease.
- Further research is necessary to determine the therapeutic benefits of propranolol in this patient population.
- A notable proportion of patients may not tolerate drug treatments for portal hypertension well, as suggested by placebo response.
Abstract:
The effect and safety of propranolol (Inderal-LA) in 95 patients with mild to moderate chronic liver disease was studied in a double-blind placebo controlled trial. Over a 12-month period, three patients in the propranolol group died compared with eight in the control population. Upper gastrointestinal bleeding occurred in the placebo group only. Twenty-five patients were withdrawn, 12 in the propranolol and 13 in the placebo group. No deterioration in clinical condition or liver function tests was observed in the propranolol-treated patients, although serum testosterone levels fell significantly compared with the control patients. This study shows that long-term treatment with propranolol is safe in patients with chronic liver disease but further studies are required to define whether or not patients will benefit. Our observations on the response to placebo suggest that a significant proportion of patients are not likely to tolerate drug treatment for portal hypertension well.