Variceal bleeding spironolactone

Both drugs are gastric irritants and should probably be avoided in patients with varices or a history of variceal bleeding or coagulopathy, or a risk thereof. Niacin can also cause thrombocytopenia. This patient has a varix and would be at risk of a variceal bleed if decompensation occurred. Niacin and acipimox also commonly cause pruritus. They are also vasodilators and may potentiate the effect of drugs that lower blood pressure (spironolactone, propranolol, furosemide), which are used to treat ascites and portal hypertension. 

Nadolol plus spironolactone in the prophylaxis of first variceal bleed in nonascitic cirrhotic patients a preliminary study. Hepatology 2003 37 359-365... 

Step 3 Reduction in portal pressure (42, 74, 113, 115) increased at an early stage, and prevention of variceal bleeding as part of a primary prophylaxis are important measures. In our experience, the development of pulmonary hypertension can be delayed (or even prevented), (s. p. 337) This might be achieved, for example, by administering (5.) molsidomine and (<5.) beta blockers (in combination with spironolactone as in Step 1). The frequent occurrence of portal colopathy (30-40%), even with colitis-like abnormalities, can be reduced by propa-nolol. (21,158) A combination of isosorbide-5-mononi-trate with nadolol has been successful in cases where treatment with beta blockers alone did not prove effective. (s. pp, 258, 355)... 

Prophylactic medication consists of f-blocking agents (propranolol, timolol, nadolol), (s. p. 323) The risk of primary bleeding could be reduced by about 50%. (69,80,145, 165,168,176) Parallel treatment with isosorbide mononitrate, molsidomine and spironolactone is recommendable from a pharmacological point of view. Portal venous pressure should be 20-30% lower. Previous studies have shown that all patients with cirrhosis and oesophageal varices should be given primary prophylactic medication. 

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