Precipitation of hepatic encephalopathy by propranolol in cirrhosis.

Continuous oral propranolol reduces portal venous pressure in patients with cirrhosis.' A controlled trial in such patients who had bled from varices showed a significantly lower incidence of rebleeding in those given propranolol.2 This led to the widespread and enthusiastic use of propranolol to prevent recurrent variceal haemorrhage in patients with cirrhosis. The beneficial effect of propranolol, however, has so far been demonstrated only in predominantly alcoholic patients who were all in good condition and in whom side effects of propranolol were few. It is not known whether prophylaxis with propranolol reduces the incidence of variceal bleeding in patients with other causes of cirrhosis or more severe liver failure. Complications of treatment with propranolol may be more common in these patients. We report on a patient in whom propranolol given to prevent recurrent variceal bleeding precipitated hepatic encephalopathy.