Octreotide or vasopressin for bleeding esophageal varices.
Acute bleeding due to esophageal varices continues to be a life-threatening complication of liver disease. Despite the availability of improved therapy, mortality continues to be high. Octreotide has been shown to be at least as effective as vasopressin in the treatment of bleeding varices, with fewer and less severe systemic adverse effects. In addition, octreotide has also been consistently associated with a decreased need for transfusions. Octreotide has been used safely in patients without serious cardiovascular disease when administered as a continuous intravenous infusion of 25 micrograms/h for 24 hours with or without an initial 100-micrograms bolus dose. Since these trials have used small numbers of patients, the ability to detect small but clinically important differences has been limited. Additional controlled trials comparing octreotide with the combination of vasopressin and nitroglycerin are needed to more clearly determine the efficacy and cost-effectiveness of therapy. Furthermore, the optimal dosage, duration, and route of administration of octreotide in the treatment of bleeding esophageal varices has yet to be determined.
Law
A W
AW
School of Pharmacy, Southwestern Oklahoma University, Oklahoma City, USA.
Gales
M A
MA
D002986:Clinical Trials as Topic; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D015282:Octreotide / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*
D005765:Gastrointestinal Agents; D006490:Hemostatics; D014667:Vasopressins; D015282:Octreotide