Which Beta-Blocker should be preferred in patients with Chronic Liver Disease?
Nadolol and propranolol are two nonselective beta blockers that are used for primary prophylaxis against variceal hemorrhage. We typically use nadolol (since it can be given once daily) at a starting dose of 40 mg per day. Propranolol is usually started at a dose of 20 mg twice a day
Carvedilol is a potent beta blocker that also has mild anti-alpha 1 adrenergic activity. It is an alternative to nonselective beta blockers for routine prophylaxis. In addition to reducing portal venous inflow through nonselective beta blockade, the anti-alpha 1 adrenergic activity leads to reduced hepatic vascular tone and hepatic resistance. This in turn leads to a further reduction in portal pressure. However, it also can result in significant drops in mean arterial blood pressure (average decrease of 23 percent in one study), which may be poorly tolerated by patients with cirrhosis