title: Acute hemodynamic effects of octreotide and terlipressin in patients with cirrhosis: a randomized comparison.
abstract: 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.
authors.affiliation: Department of Internal Medicine,Yonsei University Wonju College of Medicine, Wonju, South Korea.
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Phil Ho
authors.initials: PH
authors.lastname: Jeong
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Ji
authors.forename: Byung Su
authors.initials: BS
authors.lastname: Yoo
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Lee
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Kwon
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Kim
authors.forename: Joong Wha
authors.initials: JW
authors.lastname: Park
authors.forename: Sei Jin
authors.initials: SJ
authors.lastname: Chang
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Lee
mesh_terms: 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
chemical_list: D005765:Gastrointestinal Agents; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D015282:Octreotide