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Nonselective β-blockers are often used in patients with cirrhosis and esophageal varices to prevent variceal bleeding. A recent study has suggested that nonselective β-blockers promote more harm than benefit in patients who have cirrhosis and refractory ascites. The authors of the study suggest that these drugs should be contraindicated in these patients.
Aldosterone antagonists are the first-line diuretic therapy for moderate ascites in patients with cirrhosis. In patients who do not respond to aldosterone antagonists alone, the addition of a loop diuretic is recommended; however, for patients with recurrent ascites, receiving a combination of agents from the start might be preferable to such 'sequential' therapy.