Midodrine and Octreotide in Treatment of Cirrhosis-Related Hemodynamic Complications

@article{Karwa2009MidodrineAO,
  title={Midodrine and Octreotide in Treatment of Cirrhosis-Related Hemodynamic Complications},
  author={Rakhi Karwa and C. Brock Woodis},
  journal={Annals of Pharmacotherapy},
  year={2009},
  volume={43},
  pages={692 - 699}
}
Objective: To review studies evaluating the use of midodrine and octreotide in hemodynamic complications of cirrhosis, including ascites and hepatorenal syndrome. Data Sources: Searches of MEDLINE (1966–September 2008) and EMBASE (1974–September 2008) were conducted using the terms midodrine, octreotide, hepatorenal syndrome, ascites, cirrhosis, and paracentesis-induced circulatory dysfunction. Literature review was limited to English-language, human studies. Study Selection and Data Extraction… 

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References

SHOWING 1-10 OF 35 REFERENCES

Octreotide in hepatorenal syndrome: A randomized, double‐blind, placebo‐controlled, crossover study

It is demonstrated that, under experimental conditions, octreotide infusion combined with albumin is not effective for the treatment of HRS in cirrhotic patients.

The Effects of Chronic Treatment with Octreotide versus Octreotide plus Midodrine on Systemic Hemodynamics and Renal Hemodynamics and Function in Nonazotemic Cirrhotic Patients with Ascites

Octreotide does not improve systemic hemodynamics in nonazotemic cirrhotic patients with ascites while it impairs renal function and the addition of midodrine can ameliorate the hyperdynamic circulation without inducing renal dysfunction in these patients.

Reversal of type 1 hepatorenal syndrome with the administration of midodrine and octreotide

The long‐term administration of midodrine and octreotide seems to be an effective and safe treatment of type 1 HRS in patients with cirrhosis.

Midodrine Versus Albumin in the Prevention of Paracentesis-Induced Circulatory Dysfunction in Cirrhotics: A Randomized Pilot Study

The study suggests that midodrine may be as effective as albumin in preventing PICD in cirrhotics, but at a fraction of the cost, and can be administered orally.

A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome.

Terrlipressin is an effective treatment to improve renal function in HRS type 1 and transplantation-free survival was similar between study groups; HRS reversal significantly improved survival at day 180.

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis

During the last decade great advances have been made of water retention and dilutional hyponatremia in human cirrhosis, and evidence has develop spontaneous bacterial peritonitis, and the effectiveness of selective intestinal decontamination in the been presented implicating endothelial factors in the pathogenesis of systemic circulatory dysfunction in cirprimary and secondary prophylaxis.

Randomized trial comparing albumin and saline in the prevention of paracentesis‐induced circulatory dysfunction in cirrhotic patients with ascites

In conclusion, albumin is more effective than saline in the prevention of PICD and is a valid alternative to albumin when less than 6 L of ascitic fluid is evacuated.