title: Vasopressin vs Terlipressin in Treatment of Refractory Shock.
abstract: Arginine vasopressin (AVP) and its synthetic, long-acting analog terlipressin (TP) are potent alternative vasoconstrictors in the treatment of septic patients with catecholamine-refractive vasodilatatory shock. Recent clinical data suggest that early administration of AVP analogues may be advantageous compared to a last resort therapy. However, it is still unknown whether vasopressin and terlipressin are equally effective for hemodynamic support in shock. Despite important pharmacological differences between the two drugs the use of either substance is determined mainly by local availability and institutional inventory. The current literature suggests that neither AVP nor TP should be administered in high doses in shock. Furthermore, increasing evidence indicates that early administration of terlipressin may improve outcome as compared to a last-resort treatment. Low-dose infusion of AVP has been demonstrated to be a safe adjunct in the management of refractory shock. Evidence from experimental studies and initial clinical reports suggests that continuous low-dose infusion of TP may stabilize hemodynamics in shock. In this review we briefly described differences in pharmacokinetics and pharmacodynamics between AVP and Terlipressin (TP) in treatment of refractory shock.
authors.affiliation: University of Salerno, Salerno, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scarpati
authors.forename: O
authors.initials: O
authors.lastname: Piazza
keywords: Terlipressin; Vasopressin
references.citation: J Pharmacol Exp Ther. 1975 May;193(2):413-23
references.pmid: 167149
references.citation: Hypertension. 2000 Dec;36(6):E3-4
references.pmid: 11116134
references.citation: Intensive Care Med. 2004 Apr;30(4):597-604
references.pmid: 14673520
references.citation: Drugs Exp Clin Res. 1990;16(6):307-14
references.pmid: 2086166
references.citation: Ann Pharmacother. 2006 Dec;40(12):2170-7
references.pmid: 17148649
references.citation: Lancet. 2002 Apr 6;359(9313):1209-10
references.pmid: 11955542
references.citation: Circ Res. 1980 Jan;46(1):58-67
references.pmid: 7349918
references.citation: J Endocrinol. 1980 May;85(2):237-44
references.pmid: 7400711
references.citation: Brain Res. 1985 Dec 9;358(1-2):171-9
references.pmid: 3000512
references.citation: Circulation. 1997 Mar 4;95(5):1122-5
references.pmid: 9054839
references.citation: Front Neuroendocrinol. 1993 Apr;14(2):76-122
references.pmid: 8387436
references.citation: Crit Care Med. 2005 Sep;33(9):1897-902
references.pmid: 16148457
references.citation: J Vasc Surg. 1985 May;2(3):443-9
references.pmid: 3999236
references.citation: Stroke. 1993 Jul;24(7):1049-53; discussion 1053-4
references.pmid: 7686696
references.citation: J Endocrinol. 1998 Feb;156(2):223-9
references.pmid: 9518866
references.citation: Am J Physiol. 1982 Dec;243(6):H970-3
references.pmid: 7149050
references.citation: Blood Vessels. 1990;27(2-5):106-15
references.pmid: 2242439
references.citation: Comp Biochem Physiol A Comp Physiol. 1988;90(4):781-8
references.pmid: 2902988
references.citation: J Cardiovasc Pharmacol. 1980 Jul-Aug;2(4):367-76
references.pmid: 6156335
references.citation: Anesthesiology. 2002 Mar;96(3):576-82
references.pmid: 11873030
references.citation: Am J Physiol. 1994 Mar;266(3 Pt 2):R714-21
references.pmid: 8160864
references.citation: Crit Care Med. 2001 Sep;29(9):1756-60
references.pmid: 11546979
references.citation: Intensive Care Med. 2004 Mar;30(3):477-80
references.pmid: 14767584
references.citation: Crit Care Med. 2005 Nov;33(11):2659-66
references.pmid: 16276194
references.citation: Hepatology. 1998 Feb;27(2):351-6
references.pmid: 9462630
references.citation: Clin Transplant. 2012 Nov-Dec;26(6):E571-5
references.pmid: 23121213
references.citation: Shock. 2007 Nov;28(5):623-9
references.pmid: 17589382
references.citation: Prog Neurobiol. 1999 Apr;57(6):625-55
references.pmid: 10221785
references.citation: Crit Care Med. 2003 May;31(5):1502-8
references.pmid: 12771625
references.citation: N Engl J Med. 1995 May 18;332(20):1351-62
references.pmid: 7715646
references.citation: Am J Physiol. 1989 Feb;256(2 Pt 2):F274-8
references.pmid: 2916660
references.citation: Front Neuroendocrinol. 1994 Sep;15(3):231-74
references.pmid: 7859914
references.citation: J Clin Invest. 1987 Mar;79(3):881-7
references.pmid: 2950136
references.citation: J Vasc Res. 1997 Nov-Dec;34(6):464-72
references.pmid: 9425999
references.citation: Gastrointest Endosc. 1988 Jul-Aug;34(4):310-3
references.pmid: 3261702
references.citation: Front Neuroendocrinol. 1994 Jun;15(2):157-96
references.pmid: 7813742
references.citation: Physiol Rev. 1983 Oct;63(4):1243-80
references.pmid: 6197715
references.citation: Shock. 2004 Oct;22(4):314-9
references.pmid: 15377885
references.citation: Q J Exp Physiol. 1988 Nov;73(6):811-72
references.pmid: 2907166
references.citation: Chest. 1993 Apr;103(4):1241-5
references.pmid: 8131474
references.citation: Intensive Care Med. 2007 Sep;33(9):1669-70
references.pmid: 17530219
references.citation: Crit Care Med. 2003 Nov;31(11):2646-50
references.pmid: 14605537
references.citation: Am J Physiol. 1992 Aug;263(2 Pt 2):H491-6
references.pmid: 1387293
references.citation: Anesth Analg. 2003 Dec;97(6):1756-1763
references.pmid: 14633555
references.citation: J Clin Invest. 1985 Nov;76(5):1857-64
references.pmid: 2997293
references.citation: Endocrinology. 1978 Apr;102(4):1230-6
references.pmid: 744021
references.citation: Chest. 2001 Sep;120(3):989-1002
references.pmid: 11555538
references.citation: Intensive Care Med. 2003 Feb;29(2):301-8
references.pmid: 12594590
references.citation: Crit Care Med. 2005 Feb;33(2):455-7
references.pmid: 15699859
references.citation: Circulation. 1997 Mar 4;95(5):1108-10
references.pmid: 9054835
references.citation: Am J Physiol. 1993 Sep;265(3 Pt 2):R524-9
references.pmid: 8214142
references.citation: J Intern Med. 1999 Aug;246(2):183-90
references.pmid: 10447787
references.citation: Circulation. 2003 May 13;107(18):2313-9
references.pmid: 12732600
references.citation: Anaesth Intensive Care. 2001 Oct;29(5):463-72
references.pmid: 11669425
references.citation: Am J Physiol. 1994 Dec;267(6 Pt 2):H2413-9
references.pmid: 7528996
references.citation: Am J Physiol. 1982 Nov;243(5):H663-9
references.pmid: 7137358
references.citation: Pharmacol Rev. 1991 Mar;43(1):73-108
references.pmid: 1852013
references.citation: Am J Physiol. 1994 Aug;267(2 Pt 2):F249-56
references.pmid: 8067385