Pharmacology, clinical efficacy and safety of terlipressin in esophageal varices bleeding, septic shock and hepatorenal syndrome.
Terlipressin, a vasopressin agonist, is a commonly used drug with different indications, particularly in patients with end-stage liver disease. As a V(1) receptor agonist, it increases systemic vascular resistance, particularly in the splanchnic area, resulting in a decrease of portal pressure. Besides the approved use for variceal bleeding, terlipressin also has beneficial effects in the treatment of hepatorenal syndrome and norepinephrine-resistant septic shock. In patients with cirrhosis and variceal bleeding, the use of terlipressin reduces the portal vein pressure and decreases the pressure in esophageal varices. This can save lives when skilled endoscopists are not immediately available. Hepatorenal syndrome is associated with vasodilation in the mesenteric circulation with arterial underfilling and consecutive renal vasoconstriction. Restoration of an effective arterial blood volume can be achieved by the combination of terlipressin and volume expansion. In some cases, a success rate of up to 75% is reported. The early use of terlipressin in catecholamine-resistant shock can improve organ perfusion.
Saner
Fuat H
FH
University Essen, Department of General, Visceral and Transplant Surgery, Hufelandstr. 55, 45122 Essen, Germany. fuat.saner@uni-due.de
Canbay
Ali
A
Gerken
Guido
G
Broelsch
Christoph E
CE
D004932:Esophageal and Gastric Varices / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D008236:Lypressin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D012772:Shock, Septic / Q000188:drug therapy*; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin