Hemodynamic effects of terlipressin (a synthetic analog of vasopressin) in healthy and endotoxemic sheep

Abstract

Terlipressin reversed the hemodynamic changes in ovine endotoxemia. However, its pulmonary vasopressive effect might limit its therapeutic use in septic shock.

Review article: Organ per fusion/permeabilityrelated effects of norepinephrine and vasopressin in sepsis

“…27 The use of AVP remains controversial however, especially for terlipressin, a synthetic analogue of AVP. 28 In an experimental setting, a rising pulmonary arterial pressure is an early initial event followed by right ventricular failure; hence control of associated pulmonary hypertension can protect against edema. 24,29 In the clinical setting, lowered pulmonary arterial pressure and improved right ventricular function is a distinctive pattern in septic shock survivors.…”

Short-term effects of terlipressin bolus infusion on sublingual microcirculatory blood flow during septic shock

“…Because exogenous AVP is not available in all European countries, terlipressin (a long-acting vasopressinergic V 1 agonist) is increasingly used to stabilize mean arterial pressure (MAP) in the setting of catecholamine-refractory septic shock [1,2]. In clinical practice, terlipressin is usually administered as an intermittent bolus infusion at doses in the range 0.5 to 2 mg. Due to its vasoconstrictive effects, terlipressin has the potential to reduce cardiac output and in proportion oxygen delivery in a dose-dependent manner [1][2][3]. Whether or not these effects negatively affect microcirculatory perfusion is still not known.…”

Effects of two different dosing regimens of terlipressin on organ functions in ovine endotoxemia

“…However, experimental and clinical reports suggests that bolus injection of TP may be associated with significant adverse effects, including excessive microregional (e.g. pulmonary, coronary, and splanchnic) and systemic vasoconstriction, as well as decreases in cardiac output and oxygen delivery [6][7][8][9]. Conversely, recent studies provide evidence that continuous infusion of low-dose TP exerts beneficial hemodynamic effects with reduced side effects as compared to the ''traditional'' bolus concept [10,11].…”