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… 
EFFICACY OF MIDODRINE PLUS OCTREOTIDE IN HEPATORENAL SYNDROME: A META-ANALYSIS
Hepatorenal syndrome (HRS) is a type of renal failure occurring in patients with cirrhosis, ascites and liver failure. Among the pharmacological treatment available, terlipressin has been found to be
EFFICA C Y OF MIDODRINE PLUS OCTREOTIDE IN HEPATORENAL SYNDROME: A META - A NALYSIS
TLDR
Results of the study suggest that mortality benefits of midodrine plus octreotide appear to be significant even at three months, and this combinat ion may have HRS reversal benefits in terms of retarding the progression of the HRS rather than reversing it.
Oral midodrine is comparable to albumin infusion in cirrhotic patients with refractory ascites undergoing large-volume paracentesis: results of a pilot study
TLDR
Midodrine is as effective as albumin in reducing morbidity and mortality among patients with refractory ascites undergoing LVP at a significantly lower cost and can be more useful than shorter duration intake in terms of improvement of renal perfusion and sodium excretion.
Beneficial effect of midodrine in hypotensive cirrhotic patients with refractory ascites.
TLDR
2 patients requiring frequent LVP who benefited from midodrine treatment, as evidenced by the decreased volume of ascitic fluid drained, reduced the frequency of paracentesis and, thus, its potential risks.
The Role of Midodrine for Hypotension Outside of the Intensive Care Unit.
  • L. Gutman, Ben J. Wilson
  • Medicine
    Journal of population therapeutics and clinical pharmacology = Journal de la therapeutique des populations et de la pharamcologie clinique
  • 2017
TLDR
There is a paucity of clinical data supporting the use of midodrine to mediate recovery from septic shock, but such therapy may be uniquely appropriate in septic patients who are not candidates for intensive care unit (ICU) level of care.
Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: standard vs half albumin doses. A prospective, randomized, unblinded pilot study.
  • C. Alessandria, C. Elia, +6 authors M. Rizzetto
  • Medicine
    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
  • 2011
TLDR
This unblinded, randomized, pilot study suggests that treatment with half doses of albumin is effective in the prevention of paracentesis-induced circulatory dysfunction and its related clinical complications in cirrhotic patients with tense ascites treated by large volume paracentsis.
Comparative Clinical Pharmacokinetics of Midodrine and Its Active Metabolite Desglymidodrine in Cirrhotic Patients with Tense Ascites Versus Healthy Volunteers
TLDR
Pharmacokinetic parameters of midodrine can differ significantly in cirrhotic patients with tense ascites from those in healthy individuals and drug monitoring, dose adjustments, and drug–drug interactions should all be considered during therapy in this vulnerable patient group.
Effect of different therapeutic modalities on systemic, renal, and hepatic hemodynamics and short-term outcomes in cirrhotic patients with spontaneous bacterial peritonitis
TLDR
Turbressin and low-dose albumin plus terlipressin could be used as a therapeutic alternative to standard- dose albumin in high-risk SBP patients.
Effects of midodrine in patients with ascites due to cirrhosis: Systematic review and meta‐analysis
TLDR
Evaluating the effects of midodrine on cirrhotic ascites through a meta‐analysis and systematic review to improve systemic and renal hemodynamics in patients with cirrhosis.
Refractory ascites—the contemporary view on pathogenesis and therapy
TLDR
Cirrhotic patients with RA have poor prognoses and are at risk of developing serious complications, and only liver transplantation may improve the survival of such patients.
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References

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Octreotide in hepatorenal syndrome: A randomized, double‐blind, placebo‐controlled, crossover study
TLDR
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
TLDR
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
TLDR
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
TLDR
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.
Effects of a 7-day treatment with midodrine in non-azotemic cirrhotic patients with and without ascites.
TLDR
The administration of midodrine for 7 days improves systemic haemodynamics and sodium excretion in non-azotemic cirrhotic patients without or with ascites, suggesting that the increase in natriuresis is related to the improvement in the effective arterial blood volume.
A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome.
TLDR
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.
Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites.
TLDR
The hepatorenal syndrome is a relatively frequent complication in cirrhotic patients with ascites that is associated with an extremely short survival and Liver size, plasma renin activity, and serum sodium concentration are predictors of hepatorenAL syndrome occurrence in these patients.
Advances in the pathogenesis and treatment of type-1 and type-2 hepatorenal syndrome.
TLDR
Renal histology shows no significant lesions sufficient to justify the impairment in renal function, and recent data indicate that a reduction in cardiac output also plays a significant role.
Randomized trial comparing albumin and saline in the prevention of paracentesis‐induced circulatory dysfunction in cirrhotic patients with ascites
TLDR
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.
Terlipressin versus albumin in paracentesis‐induced circulatory dysfunction in cirrhosis: A randomized study
TLDR
The aim of the present study was to investigate the preventive effect of terlipressin on paracentesis‐induced circulatory dysfunction in patients with cirrhosis after therapeuticParacentesis and compared with that of intravenous albumin.
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