Sildenafil in severe peripheral ischemia induced by terlipressin. A case report

Ramírez, David D. Bañuelos; Alonso, S. Sánchez; Palma, María Magdalena Ramírez

doi:10.1016/j.reuma.2010.05.005

Cited by 12 publications

(9 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Brodszky et al reported that alprostadil had favorable effects of rest-pain relief and ulcer healing in critical limb ischemia 19. Besides, a recent study reported that sildenafil (50 mg q 12 hour) was effective in severe peripheral ischemia induced by terlipressin, and that the wound also improved in two weeks 13. Based on these reports, intravenous alprostadil and oral sildenafil were administered to the patient in the present case.…”

Section: Discussionmentioning

confidence: 59%

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Lee

2013

Clin Mol Hepatol

View full text Add to dashboard Cite

Variceal bleeding and hepatorenal syndrome (HRS) are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare) adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B) and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE) and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.

show abstract

Section: Discussionmentioning

confidence: 59%

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Lee

2013

Clin Mol Hepatol

View full text Add to dashboard Cite

show abstract

“…However, there are case reports of terlipressin causing skin necrosis and gangrene (table 1). 4–22 Nineteen articles reporting a total of 25 patients were analysed. Of these patients, 80% were male and the mean age was 58.88±12.36 years.…”

Section: Discussionmentioning

confidence: 99%

Terlipressin-induced ischaemic skin necrosis

et al. 2020

View full text Add to dashboard Cite

Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.

show abstract

“…42,48,50 Furthermore, ischemia has been reported in numerous case reports and case series of terlipressin, including intestinal, genital, breast, skin, and digital ischemia, and is reflected in the product labeling by a warning for the increased risk of ischemic events. [55][56][57][58][59] Although the risk of micro-and macrocirculatory ischemia are possible with any vasopressor, terlipressin should be used with caution until its ischemic risk is better quantified. 60 Other safety outcomes were similar or improved with terlipressin versus comparators.…”

Section: Terlipressinmentioning

confidence: 99%

Novel Vasopressors in the Treatment of Vasodilatory Shock: A Systematic Review of Angiotensin II, Selepressin, and Terlipressin

Rodriguez

Cucci

Kane

et al. 2018

J Intensive Care Med

View full text Add to dashboard Cite

Study Objective: Vasodilatory shock is the most common type of shock. Catecholamine vasopressors are the cornerstone of hemodynamic therapy but carry risks. Angiotensin II (AT2) was recently approved, and other novel agents (selepressin and terlipressin) are under investigation and used outside the United States (terlipressin). We performed a systematic review to summarize the efficacy and safety of these novel vasopressors and to offer guidance on their appropriate use. Design: Systematic review of controlled trials. Methods: Numerous databases were searched using terms related to angiotensin II, selepressin, terlipressin, vasopressor, and shock. Twenty-one citations, including 16 prospective comparative trials and 5 post hoc analyses reporting effects of AT2, selepressin, and terlipressin, were reviewed for data on outcomes related to hemodynamic measures, mortality, severity and duration of illness, concomitant vasopressor utilization, and adverse effects. Findings from eligible literature are described qualitatively using Cochrane methods. Results: Fourteen controlled trials were assessed after exclusion of 2 dated trials of a distinct AT2 formulation. Trials are limited for AT2 (n = 2) and selepressin (n = 1), while terlipressin was investigated in 11 small trials. Overall, the trials have an unclear risk of bias. Most report mean arterial pressure (MAP) as primary end point, and all indicate novel vasopressors increase MAP compared to placebo and to a similar degree as with catecholamine vasopressors. Mortality findings are preliminary, as they have been limited to specific subgroups in trials of terlipressin and post hoc analyses of one trial of AT2. Trials reported safety concerns for each agent including thromboembolism with AT2 and ischemia with terlipressin/selepressin. Conclusion: In this systematic review, controlled trials of novel vasopressors in treatment of vasodilatory shock were limited and of low quality. Angiotensin II, selepressin, and terlipressin appear to significantly increase MAP, but further study is required, particularly for selepressin, to determine their safety, efficacy, and role in treatment of vasodilatory shock.

show abstract

Sildenafil in severe peripheral ischemia induced by terlipressin. A case report

Cited by 12 publications

References 8 publications

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Terlipressin-induced ischaemic skin necrosis

Novel Vasopressors in the Treatment of Vasodilatory Shock: A Systematic Review of Angiotensin II, Selepressin, and Terlipressin

Contact Info

Product

Resources

About