Treatment of portal hypertension

Table 3 Vasoactive agents used in the management of acute hemorrhage

Drug	Standard dosing	Duration	Mechanism of action
Somatostatin	Initial iv bolus 250 μg (can be repeated in the first hour if ongoing bleeding); continuous iv infusion of 250 to 500 μg/h	Up to 5 d	Inhibits vasodilator hormones like glucagon causing splanchnic vasoconstriction and reduced portal blood flow
Octreotide (somatostatin analogue)	Initial iv bolus of 50 μg (can be repeated in first hour if ongoing bleeding); continuous iv infusion of 50 μg/h	Up to 5 d	Same as somatostatin, longer duration of action
Vapreotide (somatostatin analogue)	Bolus: 50 μg; continuous iv infusion of 50 μg/h	Up to 5 d	Similar to somatostatin with higher metabolic stability
Vasopressin + nitroglycerine	0.2-0.4 units/min continuous iv infusion intravenously, may titrate to a maximum of 0.8 units/min; always use in combination with nitroglycerine	Maximum of 24 h at lowest effective dose	Causes direct vasoconstriction on splanchnic circulation resulting in decreased portal blood flow
Terlipressin (vasopressin analogue)	Initial 48 h: 2 mg iv every 4 h until control of bleeding; maintenance: 1 mg iv every 4 h to prevent re-bleeding	Up to 5 d	Splanchnic vasoconstriction; the active metabolite lysine-vasopressin is gradually released over several hours thus decreasing typical vasopressin side effects