Hemodynamic and metabolic effects of terlipressin in patients with cirrhosis receiving a nonselectiveβ-blocker

Abstract

Terlipressin (Glypressin), a vasopressin analog, may be administered to patients with cirrhosis receiving a beta-adrenergic antagonist. Since terlipressin alone and beta-blockers alone both decrease portal pressure, a combination of these substances may have additional portal hypotensive effects. However, the negative side effects of terlipressin may be accentuated by long-term beta-blockade. Thus, the present study examined hemodynamic and metabolic responses to terlipressin in 12 patients receiving nonselective beta-blockers (propranolol or nadolol). Hemodynamics and oxygen (O2) -derived variables were measured prior to and 30 min after the administration (intravenous bolus) of terlipressin (1 to 2 mg, according to body weight). The hepatic venous pressure gradient and azygos blood flow significantly decreased (from 15.3 +/- 1.1 to 12.5 +/- 1.1 mm Hg, and from 0.6 +/- 0.1 to 0.5 +/- 0.1 liters/min, respectively). Arterial and pulmonary wedged pressures significantly increased. Heart rate, cardiac index, and O2 consumption were not significantly affected by terlipressin. In conclusion, in patients with cirrhosis being treated with a nonselective beta-blocker, terlipressin administration decreased portal pressure. Moreover, terlipressin induced only mild systemic hemodynamic effects in these patients. These results suggest that terlipressin can be administered in patients receiving a beta-adrenergic blocker.

Cardiovascular Dysfunction in Cirrhosis: Pathophysiological Evidence of a Cirrhotic Cardiomyopathy

“…Interestingly, this effect on PCWP was not improved after an addition of digoxin. Similar results have been obtained by the infusion of terlipressin and octreotide with increases in RAP, PAP, RVP and PCWP (84)(85)(86). In a recent study by Elizalde et al, infusion of a protein solution increased CO as well as RAP, PAP and PCWP, whereas infusion of packed red blood cells did not change these parameters (49).…”

Acute Hemodynamic Effects of Octreotide and Terlipressin in Patients with Cirrhosis: A Randomized Comparison

“…We know from previous studies that after a single intravenous bolus of terlipressin, the hemodynamic effects persist between 30-240 min (13)(14)(15)(16)(17). Again, the immediate-early period including 1 min postdose has not been extensively studied.…”

“…It has been shown to induce systemic and mesenteric vasoconstriction, at least when examined between 30-240 min after administration (13)(14)(15)(16)(17).…”

Ablation of haemodynamically unstable right ventricular outflow tract ventricular tachycardia guided by non-contact mapping

“…Similar results, with increases in the RAP, PAP, right ventricular pressure, and PCWP, have been achieved by normalising the arterial blood pressure with infusion of terlipressin and octreotide. [39][40][41] Infusion of a plasma protein solution increased CO, as well as RAP, PAP, and PCWP, whereas infusion of packed red blood cells did not change these variables. 42 In a recent study by Forrest et al, 43 oral administration of the adenosine antagonist theophylline significantly decreased PAP and PCWP, thus suggesting that adenosine could be implicated in the cardiovascular dysfunction present in cirrhosis.…”