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Beta blocker recommended for esophageal varices

Answer

Nonselective beta-blockers (NSBBs) are the recommended class of drugs for the management of esophageal varices, with propranolol and nadolol being the primary agents used.

Primary prevention of variceal hemorrhage

Secondary prevention of variceal hemorrhage

Management of beta-blockers

  • Dose adjustment: The AASLD 2017 guidelines recommend avoiding high doses of NSBBs in patients with refractory ascites and SBP (e.g., >160 mg/day of propranolol or >80 mg/day of nadolol), as they might be associated with worse outcomes . In patients with refractory ascites and severe circulatory dysfunction (SBP < 90 mmHg, serum sodium < 130 meq/L, or hepatorenal syndrome), the dose of NSBBs should be decreased or the drug should be temporarily held. NSBBs can be reintroduced after circulatory dysfunction improves

Contraindications and cautions

In conclusion, the choice of beta-blocker for esophageal varices depends on the specific clinical context, including the stage of liver disease, presence of complications, and patient-specific factors. Propranolol and nadolol are commonly used, with carvedilol being an option in certain cases. However, caution is needed in patients with severe or refractory ascites, and dose adjustments may be necessary in patients with severe circulatory dysfunction.

References

1

Gastroesophageal varices

Medical management

Guidelines

Management of beta-blockers

Pathway
AASLD 2017