Effective oral doses of propranolol, and endoscopic findings on the effects of propranolol on esophagela varices.

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Little is known about the effects of propranolol treatment on esophageal varices in cirrhotic patients as revealed by endoscopic findings, or about what sort of dose of propranolol is most effective against portal pressure. Propranolol was given in trial doses of 30mg per day to 3 patients with cirrhosis. The lowest level of serum propranolol was about 20ng/ml, which was consistent with the effective serum propranolol level for portal pressure reported in an earlier comparison with vasopressin infusion. Daily doses of 30mg of propranolol were then administered to 10 patients with cirrhosis and esophageal varices for about 30 weeks. Subsequently, endoscopic findings revealed that esophageal varices improved after propranolol treatment in 5 of these 10 patients.Measured by high liquid chromatography, serum propranolol levels were 31.9±28.6ng/ml (n=8) after 4 weeks of oral administration of 30mg of propranolol per day, 43.4±23.6ng/ml (n=6) after 12 weeks, and 27.8±22.0ng/ml (n=7) after 24 weeks. After 4 weeks of propranolol administration, hepatic and systemic hemodynamics were again measured in 4 patients. Heart rate, protal pressure, and estimated hepatic blood flow were found to have been reduced by 13.5%, 31.1%, 28.0%, respectively after propranolol treatment.This study suggests that oral doses of 30mg of propranolol per day may be sufficient for treating portal hypertension in cirrhotic patients.