Original Contribution
The American Journal of Gastroenterology (2005) 100, 631–635; doi:10.1111/j.1572-0241.2005.41381.x
Acute Hemodynamic Effects of Octreotide and Terlipressin in Patients with Cirrhosis: A Randomized Comparison
Soon Koo Baik MD1, Phil Ho Jeong MD1, Sang Won Ji MD1, Byung Su Yoo MD1, Hyun Soo Kim MD1, Dong Ki Lee MD1, Sang Ok Kwon MD1, Young Ju Kim MD1, Joong Wha Park MD1, Sei Jin Chang PhD1 and Samuel S Lee MD1
1Department of Internal Medicine; Department of Radiology; Department of Preventive Medicine and Institute of Occupational Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea; and Liver Unit, University of Calgary, Calgary, Canada
Correspondence: Dr. Soon Koo Baik, Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
Received 20 August 2004; Revised 0000; Accepted 30 November 2004.
Abstract
BACKGROUND:
Octreotide and terlipressin are widely used in acute variceal hemorrhage to reduce the bleeding rate. They purportedly act by mesenteric arterial vasoconstriction, thus reducing portal venous flow (PVF) and portal pressure. Little is known about the immediate-early hemodynamic effects of these drugs.
AIM:
To compare the acute hemodynamic effects of octreotide and terlipressin in patients with cirrhosis.
PATIENTS:
Forty-two cirrhotic patients with a history of variceal bleeding were randomized to receive either octreotide 100 
g intravenous bolus followed by a continuous infusion at 250 g/h (n = 21), or terlipressin 2 mg intravenous bolus (n = 21).
METHODS:
Mean arterial pressure (MAP), heart rate (HR), hepatic venous pressure gradient (HVPG), and PVF, assessed by duplex Doppler ultrasonography, were measured before and at 1, 5, 10, 15, 20, and 25 min after the start of drug administration.
RESULTS:
Octreotide markedly decreased HVPG (-44.5 
17.8%) and PVF (-30.6 13.6%) compared to the baseline at 1 min (p < 0.05). Thereafter, both variables rapidly returned toward the baseline, and by 5 min, no significant differences in HVPG (-7.1 28.9%) and PVF (10.2 26.2%) were noted. A similar transient effect on MAP and HR was observed. Terlipressin significantly decreased HVPG (-18.3 11.9%) and PVF (-32.6 10.5%) at 1 min (p < 0.05) and sustained these effects at all time points. The effects on arterial pressure and HR were also sustained.
CONCLUSIONS:
Octreotide only transiently reduced portal pressure and flow, whereas the effects of terlipressin were sustained. These results suggest that terlipressin may have more sustained hemodynamic effects in patients with bleeding varices.
