The effect of sotalol on cirrhotic portal hypertension. Results of a preliminary study of cardiac and hepatic hemodynamics]

Using two balloon-tipped flotation catheters introduced through the jugular vein, systemic and hepatic hemodynamic measurements were made in nine cirrhotic patients before and 15, 30, 45 and 60 minutes after intravenous injection of 1.5 mg/kg of sotalol. At 30 minutes, the occluded sus-hepatic pressure fell from 23.6 +/- 6.4 mm Hg to 16.7 +/- 5.7 mm Hg (P less than 0.025); the sus-hepatic pressure gradient decreased from 16.2 +/- 3.8 mm Hg to 8.1 +/- 2.7 mm Hg (P less than 0.0005) whereas cardiac output failed to show any significant change (6.8 +/- 2.4 l/minute prior to drug versus 5.7 +/- 2.1 l/minute). These results suggest that sotalol, a non selective beta-adrenoceptor blocking drug with weaker negative inotropic effects than propranolol is effective in lowering portal pressure. The decrease of the sus-hepatic pressure gradient induced by the dose we used (50.2 +/- 20.0%) is statistically greater than that observed by Westaby et al. with intravenous propranolol (31.0 +/- 8.2%). The absence of hepatic metabolism of the drug which is excreted untransformed by the kidney should facilitate the selection of the optimal oral dose. The rather long half-life should also allow administration of one single daily dose which improves patients' compliance. The long term oral efficacy remains to be demonstrated in further studies, but in view of the advantages that sotalol possesses over propranolol, these studies are deemed justified.