I have several "chalk talks" that I give repeatedly. One favorite is secondary prevention for cirrhotic patients. I missed this article when it was first published, but fortunately a Pharm D colleague sent it me. Carvedilol likely trump propranolol. Fortunately, carvedilol is now generic and a "$4 drug". Study shows carvedilol is effective in preventing variceal bleeding in cirrhotic patients
They had a goal of 12.5 mg b.i.d.. In this study carvedilol decreased bleeding for stage 2 varices – and was compared with banding. I like the study, and I will be teaching this new approach from now on.
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I still run into a lot of problems with hypotension with carvedilol, and am disappointed that there wasn't a propanolol arm in this study. Many of my cirrhotics have relative hypotension to begin with, and carvediolol, while cheap, might be harder to titrate safely.
In the study, they did not have any hypotension problems with carvedilol.