What does octreotide do for esophageal varices?
As a somatostatin analogue, octreotide binds with endothelial cell somatostatin receptors, inducing strong, rapid and prolonged vaso-constriction [1]. Octreotide reduces portal and variceal pressures as well as splanchnic and portal-systemic collateral blood flows [2].
When can I stop octreotide variceal bleeding?
For suspected variceal bleeding an octreotide infusion should be initiated immediately. To prevent further bleeding the drug should be continued for two to five days after endoscopic variceal ligation.
How does somatostatin treat esophageal varices?
Through vasoconstriction, somatostatin diminishes blood flow to the portal system, thus decreasing variceal bleeding. It has effects similar to those of vasopressin but does not cause coronary vasoconstriction. Somatostatin has an initial half-life of 1-3 minutes and is rapidly cleared from the circulation.
How long does octreotide drip last?
The recommended duration of octreotide therapy is based largely on expert opinion, however a 72-hour duration of treatment is likely to be unnecessary and may inappropriately increase hospital and medical costs.
Why is vasopressin given to patients with bleeding from esophageal varices?
Vasopressin has been used for 25 years to control bleeding from esophageal varices. Its efficacy is believed to be due to a direct vasoconstrictor activity on splanchnic arterioles and precapillary sphincters, with secondary reduction in portal venous blood flow and pressure.
How do beta blockers prevent variceal bleeding?
Beta blockers — Beta blockers, which are traditionally used to treat high blood pressure, are the most commonly recommended medication to prevent bleeding from varices. Beta blockers decrease pressure inside of the varices, which can reduce the risk of bleeding by 45 to 50 percent [1].
How is acute esophageal varices treated?
Treatments used to stop bleeding and reverse the effects of blood loss include:
- Using elastic bands to tie off bleeding veins.
- Medications to slow blood flow into the portal vein.
- Diverting blood flow away from the portal vein.
- Placing pressure on varices to stop bleeding.
- Restoring blood volume.
- Preventing infection.
How does somatostatin reduce portal pressure?
The effect of somatostatin on portal pressure is mediated by splanchnic arterial vasoconstriction which induces a reduction in portal blood flow and pressure. One of the most important characteristics of somatostatin is that its splanchnic effect is not accompanied by major systemic hemodynamic effects.
Is somatostatin a protein?
Somatostatin, also known as growth hormone-inhibiting hormone (GHIH) or by several other names, is a peptide hormone that regulates the endocrine system and affects neurotransmission and cell proliferation via interaction with G protein-coupled somatostatin receptors and inhibition of the release of numerous secondary …
When can I stop octreotide infusion?
If no relevant reduction in GH levels and no improvement in clinical symptoms have been achieved within 3 months of starting treatment with Octreotide, therapy should be discontinued. Initially 0.05 mg once or twice daily by s.c. injection.
What are the side effects of vasopressin?
Common side effects may include:
- fast or slow heartbeats;
- low sodium level;
- numbness or tingling;
- pounding in your head or ears;
- dizziness, spinning sensation;
- pale skin, numbness in your fingers or toes;
- stomach pain, gas, nausea, vomiting; or.
- sweating.
Can a bleeding esophageal varice be treated with octreotide?
Furthermore, the optimal dosage, duration, and route of administration of octreotide in the treatment of bleeding esophageal varices has yet to be determined. Publication types Review MeSH terms
What are the signs and symptoms of esophageal varices?
Esophageal varices usually don’t cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include: Vomiting large amounts of blood Black, tarry or bloody stools
Which is better octreotide or vasopressin for variceal bleeding?
Abstract. No specific alternative therapy demonstrated a mortality benefit. Conclusions: These results favor octreotide over vasopressin/terlipressin in the control of esophageal variceal bleeding and suggest it is a safe and effective adjunctive therapy after variceal obliteration techniques.
What are the side effects of octreotide in the Ed?
Most of the side effects of octreotide occur with prolonged use for its typical indications, as opposed to the off-label indications used in the ED. However, because of its effect on glucagon and insulin, it can cause hypoglycemia in patients with type I diabetes, and hyperglycemia in patients with type II or without diabetes [6].
