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 |