Noradrenaline versus terlipressin in the management of type 1 hepatorenal syndrome: A randomized controlled study

Saif, Riyaz U; Dar, Hilal Ahmad; Sofi, Sozia Mohammad; Andrabi, Mushtaq Saif; Javid, Gul; Zargar, Showkat Ali

doi:10.1007/s12664-018-0876-3

Cited by 54 publications

(61 citation statements)

References 33 publications

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“…HRS‐1 reversal with terlipressin is as high as 80%, and there seems to be a definite survival benefit with terlipressin and albumin when compared to placebo (or no treatment), albumin alone or terlipressin alone 2,5,27‐30 . There is no survival benefit reported when compared to other vasoconstrictors 3,27,31‐34 . Terlipressin plus albumin is more effective than midodrine/octreotide plus albumin in improving renal function in patients with HRS‐1 3 .…”

Section: Evidence For the Role Of Terlipressin In Liver Diseasementioning

confidence: 99%

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Kulkarni

Arab

Premkumar

et al. 2020

Liver International

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Vasoactive drugs form the mainstay of therapy for two of the most important complications of liver disease: hepatorenal syndrome (HRS) and acute variceal bleed (AVB). With cumulative evidence supporting the use in cirrhosis, terlipressin has been recommended for the management of HRS and AVB. However, owing to the safety concerns, terlipressin was not approved by food and drug administration (FDA) until now. In this review, we discuss the pharmacology and the major practice‐changing studies on the safety and efficacy of terlipressin in patients with cirrhosis particularly focusing on existing indications like AVB and HRS and reviewing new data on the expanding indications in liver disease. The references for this review were identified from PUBMED with MeSH terms such as “terlipressin,” “hepatorenal syndrome,” “varices, esophagal and gastric,” “ascites” and “cirrhosis.” Terlipressin, a synthetic analogue of vasopressin, was introduced in 1975 to overcome the adverse effects of vasopressin. Terlipressin is an effective drug for HRS reversal in patients with liver cirrhosis and acute‐on‐chronic liver failure. There is documented mortality benefit with terlipressin therapy in HRS and AVB. Adverse effects are common with terlipressin and need to be monitored strictly. There is some evidence to support the use of this drug in refractory ascites, hepatic hydrothorax, paracentesis‐induced circulatory dysfunction and perioperatively during liver transplantation. However, terlipressin is not yet recommended for such indications. In conclusion, terlipressin has stood the test of time with expanding indications and clear prerequisites for clinical use. Our review warrants a fresh perspective on the efficacy and safety of terlipressin.

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Section: Evidence For the Role Of Terlipressin In Liver Diseasementioning

confidence: 99%

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Kulkarni

Arab

Premkumar

et al. 2020

Liver International

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“…Moreover, cirrhotics with ascites have higher levels of norepinephrine, but the receptors are desensitized; hence, norepinephrine infusion is less effective in cirrhotics. 47 Norepinephrine has been used in shock, 37 HRS, 48 and PICD. 49 A small pilot study comparing noradrenaline with albumin reported that noradrenaline is an economical and efficacious choice over albumin.…”

Section: Pathophysiology Of Picdmentioning

confidence: 99%

Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction: A Concise Review

Kulkarni¹,

Kumar²,

Sharma³

et al. 2020

Journal of Clinical and Translational Hepatology

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Annually, 10% of cirrhotic patients with ascites develop refractory ascites for which large-volume paracentesis (LVP) is a frequently used therapeutic procedure. LVP, although a safe method, is associated with circulatory dysfunction in a significant percentage of patients, which is termed paracentesis-induced circulatory dysfunction (PICD). PICD results in faster reaccumulation of ascites, hyponatremia, renal impairment, and shorter survival. PICD is diagnosed through laboratory results, with increases of >50% of baseline plasma renin activity to a value $4 ng/mL/h on the fifth to sixth day after paracentesis. In this review, we discuss the pathophysiology and prevention of PICD.

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“…125,126 In a metaanalysis that extracted data from four studies only, no difference in reversal of HRS, 30-day mortality or recurrence of HRS was seen between terlipressin and norepinephrine. [127][128][129][130] Whereas terlipressin has been associated with cardiovascular and ischemic complications, norepinephrine was shown to have lower incidence of such adverse events. However, the ease of administration of terlipressin as a bolus dose in a peripheral vein in a ward as compared to a continuous infusion of norepinephrine in ICU setting gives a clear advantage to terlipressin despite its higher cost.…”

Section: Vasoconstrictor Agents and Albuminmentioning

confidence: 99%

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

et al. 2020

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Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan. doi: https://doi.org/10.12669/pjms.36.5.2407 How to cite this:Ali B, Salim A, Alam A, Zuberi BF, Ali Z, Azam Z, et al. HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2407 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Noradrenaline versus terlipressin in the management of type 1 hepatorenal syndrome: A randomized controlled study

Abstract: There is no difference in outcome of patients with type 1 HRS treated with noradrenaline or terlipressin. Thus, noradrenaline, which is cheaper, can be used instead of terlipressin (Clinical Trials Registry-India [CTRI] No. CTRI/2011/09/002032).

Cited by 54 publications

References 33 publications

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction: A Concise Review

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

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