NICARDIPINE INCREASES HEPATIC BLOOD-FLOW AND THE HEPATIC-CLEARANCE OF INDOCYANINE GREEN IN PATIENTS WITH CIRRHOSIS

The present study investigated the hemodynamic effects of nicardipine, a new calcium channel blocker, and placebo in 14 patients with cirrhosis. Sixty minutes after nicardipine administration (20 mg orally; n=8), there was a significant increase in hepatic blood flow (25+/-21%; p<0.05) and azygos blood flow (33+/-40%; p<0.05) but no significant change in the hepatic venous pressure gradient. As a result of the increase in hepatic blood flow and the lack of change in the hepatic venous pressure gradient, nicardipine significantly reduced hepatic sinusoidal resistance (-14+/-15%; p<0.05). Enhanced liver perfusion was associated with a significant increase in the hepatic clearance of indocyanine green (from 241+/-81 to 265+/-92 ml/min, p<0.05). A mild, well-tolerated decrease in mean arterial pressure (-10+/-6%, p<0.05), without significant changes in cardiac output, systemic vascular resistance and heart rate, was also observed. Placebo administration (n=6) did not cause significant changes in systemic or hepatic hemodynamics. The results of the present study show that nicardipine, unlike other calcium channel blockers, effectively increases hepatic blood flow and the hepatic clearance of indocyanine green in patients with cirrhosis. The acute beneficial effects of nicardipine should be confirmed in chronic studies. (C) Journal of Hepatology.