The immediate control of bleeding from oesophageal varices relies heavily on the vasoconstrictor arginine vasopressin (argipressin, Pitressin), which stops haemorrhage in 40–60% of cases and reduces transfusion requirements. However, without further treatment, such as injection sclerotherapy, rebleeding is very common and treatment with vasopressin alone does not decrease mortality.1,2 Furthermore the vasoconstrictor effect of vasopressin is associated with serious complications such as myocardial ischaemia and gangrene. Less serious but distressing side effects such as abdominal cramps and vomiting seldom necessitate cessation of therapy and show that the vasopressin is active. This article assesses a related drug, terlipressin (Glypressin - Ferring), for which the manufacturer claims important advantages.
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