The effect and safety of propranolol (Inderal-LA) in 95 patients with mild to moderate chronic liver disease was studied in a double-blind placebo controlled trial. Over a 12-month period, three patients in the propranolol group died compared with eight in the control population. Upper gastrointestinal bleeding occurred in the placebo group only. Twenty-five patients were withdrawn, 12 in the propranolol and 13 in the placebo group. No deterioration in clinical condition or liver function tests was observed in the propranolol-treated patients, although serum testosterone levels fell significantly compared with the control patients. This study shows that long-term treatment with propranolol is safe in patients with chronic liver disease but further studies are required to define whether or not patients will benefit. Our observations on the response to placebo suggest that a significant proportion of patients are not likely to tolerate drug treatment for portal hypertension well.
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