Hemodynamic, metabolic and hormonal responses to oral glibenclamide in patients with cirrhosis receiving glucose

Background: In patients with cirrhosis, glucose may induce splanchnic and r enal vasodilation. Since the antidiabetic sulfonylurea glibenclamide is kno wn to induce splanchnic and renal vasoconstriction in portal hypertensive a nimals, this drug may inhibit glucose-induced hemodynamic responses in pati ents with cirrhosis. The aim of the present study was to investigate, in pa tients with cirrhosis, the short-term effects of glibenclamide on hemodynam ic and humoral responses to glucose. Methods: Patients were randomly assign ed to receive either glibenclamide (5-mg tablet) or a placebo. All patients received an infusion of 10% glucose (62.5ml/h for 12h) that was started at the same time as glibenclamide or placebo administration. Studies were per formed prior to and 90 min after glibenclamide or placebo. Results: Glibenc lamide (i.e. glibenclamide plus glucose) significantly increased plasma ins ulin concentrations and glycemia while placebo (i.e. glucose alone) signifi cantly increased glycemia but did not change plasma insulin levels. Glibenc lamide did not significantly change the hepatic venous pressure gradient wh ile this value was significantly increased following glucose alone. Glibenc lamide did not significantly change renal blood flow and glomerular filtrat ion rate while glucose alone significantly increased renal blood flow witho ut affecting the glomerular filtration rate. Glibenclamide significantly de creased cardiac index while glucose alone did not change this value. Conclu sions: In patients with cirrhosis receiving glucose, glibenclamide blunted glucose-induced splanchnic and renal vasodilation. In addition, glibenclami de per se induced a decrease in cardiac index. These findings should be tak en into account when glibenclamide is administered to patients with cirrhos is and type 2 diabetes.