Session 8 ‒ Complications in the Medical Treatment of Portal Hypertension

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

“…Although some of these side effects disappear with time or after dose reduction, treatment withdrawal occurs in 15% of patients. Trials in which nadolol was used have reported lower rates of side effects (Ϸ10%) than those involving propranolol (Ϸ17%) 60 ; however, direct comparisons have not been performed.…”

“…The clinical usefulness of vasopressin is limited by its multiple side effects, which are related to its potent vasoconstrictive properties, including cardiac and peripheral ischemia, arrhythmias, hypertension, and bowel ischemia. 60 Although its efficacy and safety are significantly improved by the addition of nitrates, 50 side effects of combination therapy are still higher than those associated with terlipressin, somatostatin, or somatostatin analogues 35 and, therefore, it can only be used continuously at the highest effective dose for a maximum of 24 hours to minimize the development of side effects. Vasopressin is administered at a continuous IV infusion of 0.2-0.4 units/minute that can be increased to a maximal dose of 0.8 units/minute.…”

“…60 The most common side effects related to ␤-blockers in cirrhosis are lightheadedness, fatigue, and shortness of breath. Although some of these side effects disappear with time or after dose reduction, treatment withdrawal occurs in 15% of patients.…”

Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis

“…Approximately 15% of patients from trials have relative contraindications to the use of β-blockers, such as asthma, insulin-dependent diabetes (with episodes of hypoglycemia), and peripheral vascular disease (60). The most common side effects related to β-blockers in cirrhosis are lightheadedness, fatigue, and shortness of breath.…”

“…It reduces blood flow to all splanchnic organs, thereby leading to a decrease in portal venous inflow and to a decrease in portal pressure. The clinical usefulness of vasopressin is limited by its multiple side effects, which are related to its potent vasoconstrictive properties, including cardiac and peripheral ischemia, arrhythmias, hypertension, and bowel ischemia (60). Although its efficacy and safety are significantly improved by the addition of nitrates (50), side effects of combination therapy are still higher than those associated with terlipressin, somatostatin, or somatostatin analogues (35) and, therefore, it can only be used continuously at the highest effective dose for a maximum of 24 hours to minimize the development of side effects.…”