Hemodynamic and metabolic effects of terlipressin in patients with cirrhosis receiving a nonselective beta-blocker.
Terlipressin (Glypressin), a vasopressin analog, may be administered to patients with cirrhosis receiving a beta-adrenergic antagonist. Since terlipressin alone and beta-blockers alone both decrease portal pressure, a combination of these substances may have additional portal hypotensive effects. However, the negative side effects of terlipressin may be accentuated by long-term beta-blockade. Thus, the present study examined hemodynamic and metabolic responses to terlipressin in 12 patients receiving nonselective beta-blockers (propranolol or nadolol). Hemodynamics and oxygen (O2) -derived variables were measured prior to and 30 min after the administration (intravenous bolus) of terlipressin (1 to 2 mg, according to body weight). The hepatic venous pressure gradient and azygos blood flow significantly decreased (from 15.3 +/- 1.1 to 12.5 +/- 1.1 mm Hg, and from 0.6 +/- 0.1 to 0.5 +/- 0.1 liters/min, respectively). Arterial and pulmonary wedged pressures significantly increased. Heart rate, cardiac index, and O2 consumption were not significantly affected by terlipressin. In conclusion, in patients with cirrhosis being treated with a nonselective beta-blocker, terlipressin administration decreased portal pressure. Moreover, terlipressin induced only mild systemic hemodynamic effects in these patients. These results suggest that terlipressin can be administered in patients receiving a beta-adrenergic blocker.
Vachiery
F
F
Laboratoire d'Hémodynamique Splanchnique, Unité de Recherches de Physiopathologie Hépatique, INSERM U-24, Clichy, France.
Moreau
R
R
Gadano
A
A
Yang
S
S
Sogni
P
P
Hadengue
A
A
Cailmail
S
S
Soupison
T
T
Lebrec
D
D
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D004357:Drug Synergism; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects*; D017082:Portal Pressure / Q000187:drug effects; D013152:Splanchnic Circulation / Q000187:drug effects; D000077585:Terlipressin
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin