Cardiovascular effects of octreotide in patients with hepatic cirrhosis

Abstract

Octreotide is thought to reduce splanchnic and variceal blood flow with minimal effects on the systemic circulation in cirrhotic patients with portal hypertension. However, we noticed significant bradycardia in some patients immediately after administration of bolus doses of octreotide. Therefore, we investigated the effect of intravenous octreotide on systemic hemodynamics in 59 patients with cirrhosis. In two double-blind, placebo-controlled protocols, 32 patients received a 25-micrograms bolus and 20 patients received an infusion of 50-micrograms/hr of octreotide/placebo. Immediately after the bolus dose of octreotide was administered, there were significant reductions in pulse rate (77 +/- 3 vs. 65 +/- 3 beats per minute, P < .01) and cardiac output (9.2 +/- 0.8 vs. 7.9 +/- 0.8 L/min; P < .01) and significant increases in mean arterial pressure (81 +/- 3 vs. 87 +/- 3 mm Hg; P < .05), mean pulmonary artery pressure (9.1 +/- 1.0 vs. 16.6 +/- 1.5 mm Hg; P < .01), right atrial pressure (3.8 +/- 0.8 vs. 6.6 +/- 1.0 mm Hg; P < .01), right ventricular pressure (7.1 +/- 0.6 vs. 12.5 +/- 1.3 mm Hg; P < .01), pulmonary capillary wedge pressure (4.8 +/- 0.8 vs. 11.2 +/- 1.4 mm Hg; P < .01), systemic vascular resistance, and pulmonary vascular resistance. Thirty minutes after the start of the infusion, there were significant increases in mean right atrial pressure, right ventricular pressure, pulmonary artery pressure, and pulmonary capillary wedge pressure. This study suggests that intravenous octreotide has significant effects on the systemic circulation in patients with cirrhosis and that these effects appear to be more marked after administration of bolus doses.

Hemodynamic Effects of a Combination of Octreotide and Terlipressin Patients with Viral Hepatitis Related Cirrhosis

“…Some studies have found a decrease in portal pressure (41), while others have failed to achieve such a bene cial effect (19)(20)(21). A transient reduction of the azygos blood ow and a rapid cardiovascular effect has also been reported (22,42). The heterogeneity of these results may be due to the time used to measure the effects following octreotide administration.…”

The Effects of Chronic Treatment with Octreotide versus Octreotide plus Midodrine on Systemic Hemodynamics and Renal Hemodynamics and Function in Nonazotemic Cirrhotic Patients with Ascites

“…However, Gines et al indicated that the use of SMS might impair renal function in cirrhotic patients, mainly those with ascites (17). In addition, octreotide produced a transient effect (18,19) or no effect (20)(21)(22) on systemic hemodynamics in nonazotemic cirrhotic patients, while the effects on renal hemodynamics and function were controversial (16,(22)(23)(24)(25)(26).…”

Octreotide Bolus Injection and Azygos Blood Flow in Patients With Cirrhosis

“…However, any meaningful observations from subset analyses are difficult to derive owing to the small sample size. Provided that the mechanisms of action of OCT on human splanchnic vasculature are incompletely known, 13 one could speculate on variable effects of the OCT on cell membrane receptors of vascular smooth muscle, 14 on the release of gastrointestinal hormones, such as glucagon that have been reported to affect splanchnic blood flow, 15 or on possible systemic effects after OCT injection, 16,17 although this seems unlikely in view of the stable arterial blood pressure.…”