Clinical

Irbesartan added to propranolol may improve cirrhosis therapy

Last Updated: 2008-06-20 18:19:00 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Combination therapy with irbesartan and propranolol can produce greater sodium excretion than use of propranolol alone in certain patients with cirrhosis, according to German researchers.

In the May issue of the American Journal of Gastroenterology, Dr. Michael Schepke of the University of Bonn and colleagues note that angiotensin II type-1 receptor antagonists such as irbesartan have been shown to lower portal pressure in some cirrhotic patients but may cause severe adverse events.

Standard therapy for portal pressure is propranolol, but less than half of patients achieve adequate pressure reduction. To evaluate the use of the two drugs together, the researchers studied 32 patients with cirrhosis.

All of the patients received 20 mg propranolol twice daily, and were randomized to irbesartan titrated up to 300 mg per day or placebo.

At 8 weeks, portal pressure declined in the two groups.

The average daily dosage of irbesartan by the end of the study was 272 mg and the treatment was well tolerated.

In patients given the combination therapy there was a significant increase in urinary sodium excretion from 122 nmol to 230 nmol per 24 hours, while sodium excretion remained unchanged in the propranolol plus placebo patients.

"Although such a combination treatment is not particularly useful for its portal hypotensive effects as compared to propranolol alone," the researchers conclude, "it expands the pharmacologic armamentarium in the management of selected patients with chronic liver disease by offering potential antifibrotic and natriuretic benefits."

Am J Gastroenterol 2008;103:1152-1158.