Terlipressin: a promising vasoactive agent in hemodynamic support of septic shock

Background: At present, terlipressin is predominantly used for the management of bleeding gastric and esophageal varices, as well as hepato-renal syndrome secondary to liver cirrhosis. Owing to its high and relatively selective affinity to vascular V1 receptors, terlipressin is also increasingly used as an adjunct vasopressor agent in the management of vasodilatory hyperdynamic septic shock. Objective: This review article aims to summarize the available knowledge related to hemodynamic support with terlipressin in septic shock. Methods: For literature search, PubMed and specific keywords from the MeSH Database were used. Results/conclusions: Terlipressin represents an effective pressor agent in patients with catecholamine-unresponsive septic shock. However, caution should be exercised, as terlipressin may contribute dose-dependently to vasoconstriction and a reflectory decrease in cardiac output. Additional studies are needed to clarify: i) the optimal time of therapy institution; ii) the efficacy and the dosages of continuous infusion versus bolus administration; and iii) the safety and efficacy of this compound in comparison with other nonspecific vasopressinergic drugs, such as arginine vasopressin. Whether or not terlipressin may improve the outcome of septic shock patients compared with standard therapy with catecholamines remains to be determined