Controlled Trial of Terlipressin ('Glypressin') Versus Vasopressin in the Early Treatment of Oesophageal Varices

Freeman, Jan G.; Lishman, A H; Cobden, I; Record, C. O.

doi:10.1016/s0140-6736(82)91689-0

Cited by 153 publications

(35 citation statements)

References 22 publications

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“…V1a receptor-mediated constriction of the vascular smooth muscles and the gastrointestinal tracts has been used in the treatment of acute esophageal variceal bleeding (34,240). Terlipressin, an AVP analog, is preferred over AVP for esophageal bleeding, because it yields fewer adverse events and is active for a longer period (161). In fact, terlipressin is the only drug that has been shown to improve survival by significantly improving bleeding control.…”

Section: A Avp and Its Analogsmentioning

confidence: 99%

Vasopressin V1a and V1b Receptors: From Molecules to Physiological Systems

Koshimizu

Nakamura

Egashira

et al. 2012

Physiological Reviews

324

297

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The neurohypophysial hormone arginine vasopressin (AVP) is essential for a wide range of physiological functions, including water reabsorption, cardiovascular homeostasis, hormone secretion, and social behavior. These and other actions of AVP are mediated by at least three distinct receptor subtypes: V1a, V1b, and V2. Although the antidiuretic action of AVP and V2 receptor in renal distal tubules and collecting ducts is relatively well understood, recent years have seen an increasing understanding of the physiological roles of V1a and V1b receptors. The V1a receptor is originally found in the vascular smooth muscle and the V1b receptor in the anterior pituitary. Deletion of V1a or V1b receptor genes in mice revealed that the contributions of these receptors extend far beyond cardiovascular or hormone-secreting functions. Together with extensively developed pharmacological tools, genetically altered rodent models have advanced the understanding of a variety of AVP systems. Our report reviews the findings in this important field by covering a wide range of research, from the molecular physiology of V1a and V1b receptors to studies on whole animals, including gene knockout/knockdown studies.

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Section: A Avp and Its Analogsmentioning

confidence: 99%

Vasopressin V1a and V1b Receptors: From Molecules to Physiological Systems

Koshimizu

Nakamura

Egashira

et al. 2012

Physiological Reviews

324

297

View full text Add to dashboard Cite

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“…Others have looked primarily at the reduction of portal pressure as the outcome. Vasopressin and terlipressin (glypressin) have been used to induce constriction of the splanchnic vasculature resulting in a decrease in portal venous flow [44][45][46]. The advantages of terlipressin (an analogue of lysine vasopressin) is that it is longer acting and has fewer side effects than vasopressin.…”

Section: Gastric Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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Esophageal varices are the most common site of variceal bleeding. However, bleeding from varices that are not located in the esophagus may account for up to 30% of all variceal bleeding. Significant varices can occur in the stomach, duodenum, jejunum, ileum, colon, rectum, and biliary tree. They can also occur at the site of a surgical ostomy. These types of varices bleed less commonly than esophageal varices, but they can also be far more difficult to diagnose and treat. The absence of stigmata of recent esophageal variceal bleeding and certain clues in the patient’s history and clinical presentation should raise the clinician’s suspicion of an extraesophageal site of variceal bleeding. Particularly, patients with extrahepatic causes of portal hypertension, cirrhotic patients with a prior history of gastrointestinal surgery, and patients who present with profound bleeding but without hematemesis need to be evaluated further if an obvious site of esophageal variceal bleeding is not seen on initial endoscopy. In this article, we review the features particular to extraesophageal varices as well as the diagnosis and management of bleeding from these varices. We use the term extraesophageal rather than ectopic because the term ectopic varices implies exclusion of both esophageal and gastric varices.

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“…In uno studio di confronto terlipressina vs. vasopressina (0,4 unità/minuto per infusione ev continua) controllato contro placebo e condotto nel 1982 da Freeman su 19 pazienti con emorragia da varici esofagee, terlipressina (2mg ev ogni 6 ore) è stata in grado di controllare il sanguinamento nel 70% dei pazienti, contro il 9% dei pazienti che hanno ricevuto vasopressina, i quali, inoltre, hanno avuto bisogno di più trasfusioni di sangue [21]. L'efficacia di vasopressina in questo studio, tuttavia, è insolitamente bassa; la maggior parte degli studi pubblicati, come accennato più sopra, ne attesta un valore vicino al 50%.…”

Section: Studi Controllati Contro Placebounclassified

Terlipressina: profilo farmacologico clinico, terapeutico e farmacoeconomico nel trattamento delle varici esofagee

Pradelli¹

2005

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INTRODUZIONELa formazione di varici esofagee e gastriche è una grave ma comune conseguenza dell'ipertensione portale, dovuta nella maggioranza dei casi a cirrosi epatica. Esse sono riscontrabili in circa il 30% dei pazienti cirrotici ben compensati e nel 60% di quelli con cirrosi scompensata [1]. Il rischio di rottura è circa del 10-20% [1,2] per anno se vengono considerati tutti i pazienti con varici, superiore al 20-30% nei soggetti con varici di grandi dimensioni [3]. La rottura di varici esofagee è responsabile di oltre un quarto dei decessi nei pazienti cirrotici [4]: nel 30-50% dei casi il primo episodio di emorragia da varice è letale [1], circa un terzo dei sopravvissuti presenta una recidiva entro i 6 mesi dal primo episodio e due terzi entro i 2 anni, con tassi di mortalità del 30-50% per ogni episodio [5,6,7]. Oltre al costo in termini di sopravvivenza, gli episodi emorragici a carico delle varici esofagee o gastriche comportano un elevatissimo consumo di risorse sanitarie: il paziente con sanguinamento attiTerlipressina: profilo farmacologico clinico, terapeutico e farmacoeconomico nel trattamento delle varici esofagee Lorenzo Pradelli* ABSTRACTThe formation and rupture of esophageal and gastric varices are severe but common complications of hepatic cirrhosis. They represent the cause underlying more than one forth of all deaths in cirrhotic patients and exact an impressive burden in terms of survival, quality of life and health care resource consumption. Therapeutic options for the control of active variceal hemorrhage comprise pharmacological agents, endoscopic techniques and surgery. Of these, the only options immediately available in the absence of highly specialized medical personnel are vasoactive drugs, namely vasopressin and derivatives and somatostatin and derivatives. Despite this clear advantage, the role of pharmacological treatment is still debated; furthermore, there's no consensus on the drug of choice for variceal bleeding control. In this paper the main pharmacological and clinical features of terlipressin, a synthetic vasopressin analog, are outlined, as well as a frame for its pharmacoeconomical evaluation. Terlipressin is the only vasoactive drug that demonstrated survival benefits in cirrhotic patients with active variceal hemorrhage, even in those treated with endoscopic sclerotherapy, and is characterized by a favorable risk/benefit ratio. The relative cost-effectiveness of the different drugs, nevertheless, is yet to be determined by methodologically rigorous studies, partly because at the present state of the research there still are clinical and economical uncertainties to be cleared.

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Controlled Trial of Terlipressin ('Glypressin') Versus Vasopressin in the Early Treatment of Oesophageal Varices

Cited by 153 publications

References 22 publications

Vasopressin V1a and V1b Receptors: From Molecules to Physiological Systems

Vasopressin V1a and V1b Receptors: From Molecules to Physiological Systems

Extraesophageal Varices

Terlipressina: profilo farmacologico clinico, terapeutico e farmacoeconomico nel trattamento delle varici esofagee

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