EVL + propranolol + isosorbide 5 mononitrate

This therapy is a combination regimen consisting of endoscopic variceal ligation (EVL), the non-selective beta-blocker propranolol, and the nitrate vasodilator isosorbide 5-mononitrate (ISMN). It is primarily used for secondary prophylaxis in patients with portal hypertension who have experienced esophageal variceal bleeding. - **Endoscopic Variceal Ligation (EVL):** A procedure that mechanically obliterates esophageal varices to prevent rebleeding. - **Propranolol:** A non-selective beta-adrenergic receptor antagonist that reduces portal venous pressure by decreasing cardiac output and splanchnic blood flow. - **Isosorbide 5-mononitrate:** An organic nitrate that acts as a vasodilator, further reducing portal pressure by dilating venous capacitance vessels. The combination aims to maximize reduction in portal hypertension through both mechanical (ligation) and pharmacological means (beta-blockade and vasodilation). However, studies indicate that while this combination may lower rebleeding rates compared to some monotherapies, it does not significantly outperform EVL alone in preventing rebleeding but may increase adverse effects[1][2][3][4].

Other names

EVL plus propranolol and isosorbide 5 mononitrateendoscopic variceal ligation plus propranolol and ISMN