Historical overview and review of current day treatment in the management of acute variceal haemorrhage

Table 3 Comparison of vasoactive pharmacological therapies used in variceal haemorrhage

	Octreotide	Somatostatin	Terlipressin
Mode of administration	Bolus followed by IV infusion	Bolus followed by IV infusion	IV bolus
Class	Somatostatin analogue		Synthetic analogue of Vasopressin
Indication	Variceal haemorrhage	Variceal haemorrhage	Variceal haemorrhage Hepatorenal syndrome
Proposed mechanism of action	Mechanism unclear Inhibition of glucagon-mediated splanchnic vasodilatation and reduction of postprandial gut hyperemia	Amino-acid peptide that reduced splanchnic blood flow (especially azygous). Prevent release of vasoactive peptides	V1 receptors blockade causing splanchnic vasoconstriction
Dose	Bolus of 50 μg, followed by an infusion of 50 μg per hour for up to 5 d	Infusion of 250-500 μg/h	2 mg bolus followed by 1 mg every 4 h for 3-5 d
Side effects/cautions	Vomiting, abdominal pain, nausea, hepatitis, abnormal LFTs, diahorrea, hypoglycaemia. Rarely arrhythmias, dyspnoea, pancreatitis, rash and alopecia	Loss of appetite, nausea, vomiting, abdominal, diahorrea and fatigue	Vasoconstrictive side-effects: myocardial ischemia, limb ischemia (avoid if peripheral vascular disease), nausea and diahorrea. Hyponatraemia

LFTs: Liver function tests.