title: Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study.
abstract: In patients with cirrhosis and hepatorenal syndrome (HRS), terlipressin has been used either as continuous intravenous infusion or as intravenous boluses. To date, these two approaches have never been compared. The goal of this study was to compare the administration of terlipressin as continuous intravenous infusion versus intravenous boluses in the treatment of type 1 HRS. Seventy-eight patients were randomly assigned to receive either continuous intravenous infusion (TERLI-INF group) at the initial dose of 2 mg/day or intravenous boluses of terlipressin (TERLI-BOL group) at the initial dose of 0.5 mg every 4 hours. In case of no response, the dose was progressively increased to a final dose of 12 mg/day in both groups. Albumin was given at the same dose in both groups (1 g/kg of body weight at the first day followed by 20-40 g/day). Complete response was defined by decrease of serum creatinine (sCr) from baseline to a final value ≤133 μmol/L, partial response by a decrease ≥50% of sCr from baseline to a final value >133 μmol/L. The rate of adverse events was lower in the TERLI-INF group (35.29%) than in the TERLI-BOL group (62.16%, P < 0.025). The rate of response to treatment, including both complete and partial response, was not significantly different between the two groups (76.47% versus 64.85%; P value not significant). The mean daily effective dose of terlipressin was lower in the TERLI-INF group than in the TERLI-BOL group (2.23 ± 0.65 versus 3.51 ± 1.77 mg/day; P < 0.05).
  
  
  CONCLUSIONS
  Terlipressin given by continuous intravenous infusion is better tolerated than intravenous boluses in the treatment of type 1 HRS. Moreover, it is effective at doses lower than those required for intravenous bolus administration.
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Cavallin
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.|Unit of Hepatic Emergencies and Liver Transplantation, University of Padova, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piano
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Romano
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.|Unit of Hepatic Emergencies and Liver Transplantation, University of Padova, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Fasolato
authors.affiliation: Department of Cardiovascular and Thoracic Sciences, University of Padova, Italy.
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: General Hospital of Melegnano, Milan, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Benetti
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Gola
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Morando
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Stanco
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rosi
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Sticca
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Hepatobiliary Surgery and Liver Transplantation, University of Padova, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy.|Unit of Hepatic Emergencies and Liver Transplantation, University of Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D000368:Aged; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy / Q000453:epidemiology; D008236:Lypressin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin