propranolol + spironolactone

This combination therapy consists of propranolol, a non-selective beta-adrenergic receptor antagonist, and spironolactone, a mineralocorticoid receptor antagonist. It was evaluated in a Phase 4 clinical trial (NCT00188045) conducted by University Hospital, Angers, to assess its hemodynamic effects in patients with alcoholic cirrhosis. Propranolol reduces portal hypertension by decreasing splanchnic blood flow through the blockade of beta-1 and beta-2 receptors, which leads to reduced cardiac output and splanchnic vasoconstriction. Spironolactone acts as a potassium-sparing diuretic by antagonizing the mineralocorticoid receptor, which helps manage fluid retention (ascites) and may further modulate portal pressure by decreasing plasma volume and potentially intrahepatic resistance. The combination is intended to provide synergistic effects on the hepatic venous pressure gradient (HVPG) in cirrhotic patients.

Other names

Propranolol - Spironolactone