title: Midodrine and octreotide in treatment of cirrhosis-related hemodynamic complications.
abstract: OBJECTIVE
  To review studies evaluating the use of midodrine and octreotide in hemodynamic complications of cirrhosis, including ascites and hepatorenal syndrome.
  
  
  METHODS
  Searches of MEDLINE (1966-September 2008) and EMBASE (1974-September 2008) were conducted using the terms midodrine, octreotide, hepatorenal syndrome, ascites, cirrhosis, and paracentesis-induced circulatory dysfunction. Literature review was limited to English-language, human studies.
  
  
  METHODS
  Studies identified from data sources were considered for review. Studies were excluded if primary therapy involved any of the following: transjugular intrahepatic portosystemic shunt procedure, medications other than midodrine or octreotide, or patients included for treatment or prevention of portal hypertension and/or variceal bleeding. Pharmacokinetic/pharmacodynamic studies and studies using retrospective data collection were excluded. Seven studies were included in this review.
  
  
  RESULTS
  Midodrine and octreotide in combination or alone have shown conflicting results for systemic and renal hemodynamics and renal function in patients with cirrhosis-related complications. Patients with ascites being treated with midodrine, alone or in combination with octreotide, showed significant changes in systemic hemodynamics, without a correlating change in renal perfusion. Studies comparing the use of midodrine with use of albumin for the prevention of paracentesis-induced circulatory dysfunction (PICD) showed no incidence of PICD in either treatment group. In hepatorenal syndrome, patients using midodrine with octreotide showed significant changes in systemic hemodynamics and improvements in renal perfusion. This regimen's effect on survival is yet to be determined.
  
  
  CONCLUSIONS
  Available evidence shows inconsistent results for the effectiveness and safety of midodrine and octreotide use in cirrhotic patients. Because of the contradictory results, longer treatment duration and increased number of study participants are necessary to determine the proper use of midodrine and octreotide in these patients.
authors.affiliation: Harrison School of Pharmacy, Auburn University, AL, USA. rzk0004@auburn.edu
authors.forename: Rakhi
authors.initials: R
authors.lastname: Karwa
authors.forename: C Brock
authors.initials: CB
authors.lastname: Woodis
mesh_terms: D001201:Ascites / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006530:Hepatorenal Syndrome / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008879:Midodrine / Q000627:therapeutic use*; D015282:Octreotide / Q000627:therapeutic use*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
chemical_list: D008879:Midodrine; D015282:Octreotide