Acute hemodynamic effects of octreotide and terlipressin in patients with cirrhosis: a randomized comparison.
BACKGROUND
Octreotide and terlipressin are widely used in acute variceal hemorrhage to reduce the bleeding rate. They purportedly act by mesenteric arterial vasoconstriction, thus reducing portal venous flow (PVF) and portal pressure. Little is known about the immediate-early hemodynamic effects of these drugs.


OBJECTIVE
To compare the acute hemodynamic effects of octreotide and terlipressin in patients with cirrhosis.


METHODS
Forty-two cirrhotic patients with a history of variceal bleeding were randomized to receive either octreotide 100 microg intravenous bolus followed by a continuous infusion at 250 microg/h (n = 21), or terlipressin 2 mg intravenous bolus (n = 21).


METHODS
Mean arterial pressure (MAP), heart rate (HR), hepatic venous pressure gradient (HVPG), and PVF, assessed by duplex Doppler ultrasonography, were measured before and at 1, 5, 10, 15, 20, and 25 min after the start of drug administration.


RESULTS
Octreotide markedly decreased HVPG (-44.5 +/- 17.8%) and PVF (-30.6 +/- 13.6%) compared to the baseline at 1 min (p < 0.05). Thereafter, both variables rapidly returned toward the baseline, and by 5 min, no significant differences in HVPG (-7.1 +/- 28.9%) and PVF (10.2 +/- 26.2%) were noted. A similar transient effect on MAP and HR was observed. Terlipressin significantly decreased HVPG (-18.3 +/- 11.9%) and PVF (-32.6 +/- 10.5%) at 1 min (p < 0.05) and sustained these effects at all time points. The effects on arterial pressure and HR were also sustained.


CONCLUSIONS
Octreotide only transiently reduced portal pressure and flow, whereas the effects of terlipressin were sustained. These results suggest that terlipressin may have more sustained hemodynamic effects in patients with bleeding varices.
Baik
Soon Koo
SK
Department of Internal Medicine,Yonsei University Wonju College of Medicine, Wonju, South Korea.
Jeong
Phil Ho
PH
Ji
Sang Won
SW
Yoo
Byung Su
BS
Kim
Hyun Soo
HS
Lee
Dong Ki
DK
Kwon
Sang Ok
SO
Kim
Young Ju
YJ
Park
Joong Wha
JW
Chang
Sei Jin
SJ
Lee
Samuel S
SS
D001794:Blood Pressure / Q000187:drug effects; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008102:Liver Circulation / Q000187:drug effects; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000503:physiopathology; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000494:pharmacology*; D011168:Portal System / Q000187:drug effects; D000077585:Terlipressin; D018616:Ultrasonography, Doppler, Duplex; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology*; D014690:Venous Pressure / Q000187:drug effects
D005765:Gastrointestinal Agents; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D015282:Octreotide