Haemodynamic effects of propranolol, octreotide and their combination during fasting and post-prandial splanchnic hyperaemia in patients with cirrhosis

Background/aims This double-blind study was designed to evaluate the haemod ynamic effect of two drugs, propranolol and octreotide, and their combinati on in patients with cirrhosis. Methods Fifteen patients with cirrhosis were randomly assigned to two group s receiving either octreotide subcutaneously at 100 mug ('octreotide' group , n = 9) or propranolol orally at 40 mg followed by a subcutaneous dose of octreotide (100 mug) after 1 h ('propranolol + octreotide' group, n = 6); t hen, after 30 min, a standard meal was administered to both groups. The hep atic vein pressure gradient by hepatic vein catheterization, portal and sup erior mesenteric artery blood flow velocity, superior mesenteric artery pul satility index by the echo Doppler duplex system were recorded at baseline, 1 h after propranolol in the 'propranolol + octreotide' group, and in both groups 30 min after octreotide and 30 min after meal. Results At fast, propranolol was more active in decreasing portal pressure (from 16 +/- 2.2 to 12.7 +/- 3.8 mmHg, -20%, P < 0.05) as compared to octre otide (from 18.6 +/- 4.8 to 16.6 +/- 4.3 mmHg, -11%, P < 0.05). Conversely, octreotide was more active on the mean blood flow velocity of superior mes enteric artery (from 22.8 +/- 5 to 19 +/- 4.5 cm/receiving beta -blockers s howed, also, a trend to increase the mesenteric vascular resistances (pulsa tility index from 3.14 +/- 0.69 to 3.68 +/- 1.29, +17%, not significant (NS )) which had not been affected by previous treatment with propranolol. Afte r the meal, a reduction of the expected hyperaemic response occurred in bot h groups. Conclusions The combined acute haemodynamic effect of this association sugg ests the possible combination of these two drugs in critical situations, su ch as variceal bleeding in patients receiving beta -blockers, The simultane ous use of echo-Doppler and hepatic vein catheterization permitted us a mor e complete analysis of the acute haemodynamic events. Eur J Gastroenterol H epatol 13:163-169 (C) 2001 Lippincott Williams & Wilkins.