Acute and chronic effects of isosorbide-5-mononitrate administration on effective renal plasma flow and the renin-aldosterone system in cirrhotic patients

Background and Aims: Isosorbide-5-mononitrate (ISMO) has been shown to be e ffective in reducing the risk of variceal bleeding in patients with cirrhos is. However, recent studies have suggested that this drug compromises renal function. The present study was conducted to assess the acute and chronic effects of ISMO on effective renal plasma flow (ERPF) and the renin-aldoste rone profile in cirrhotic patients. Methods: Fifteen cirrhotic patients were included in the present study. The mean arterial pressure (MAP), heart rate (HR), serum renin concentration ( SR), ERPF and plasma aldosterone concentration (PA) were checked before ISM O treatment (baseline study), after a single oral dose of 20 mg ISMO (acute effect study) and after 3 weeks of ISMO treatment (chronic effect study). Results: Our data showed that the oral administration of a single dose (20 mg) of ISMO to cirrhotic patients was associated with significant decreases in ERPF (from 405.18 to 369.06 mL/min) and MAP (from 93.26 to 86.40 mmHg), and increases in HR (from 65.53 to 70.06 beats/min), SR (from 24.15 to 54. 41 pg/mL), and PA (from 105.1 to 148.7 pg/mL). However, no significant chan ges were observed in HR, MAP, PA, SR, or ERPF after 3 weeks of ISMO treatme nt when compared with the baseline study. Conclusions: The administration of ISMO causes a decrease in ERPF in cirrho tic patients and its use in patients with renal impairment should be consid ered cautiously. (C) 2000 Blackwell Science Asia Pty Ltd.