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

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Abstract
Terlipressin (Glypressin), a vasopressin analog, may be administered to patients with cirrhosis receiving aβ-adrenergic antagonist. Since terlipressin alone andβ-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-termβ-blockade. Thus, the present study examined hemodynamic and metabolic responses to terlipressin in 12 patients receiving nonselectiveβ-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 nonselectiveβ-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 aβ-adrenergic blocker.