From the Guidelines
Octreotide is the vasoactive drug of choice in the management of variceal hemorrhage due to its safety profile, as evidenced by a 2021 updated systematic review and meta-analysis 1. The use of octreotide in the management of esophageal varices is supported by its ability to reduce splanchnic blood flow and portal pressure, which helps control active bleeding from esophageal varices. Key points to consider when using octreotide for esophageal varices include:
- Administration: typically administered as an intravenous bolus of 50 micrograms followed by a continuous infusion of 50 micrograms per hour for 2-5 days
- Initiation: should be initiated as soon as variceal bleeding is suspected, even before endoscopic confirmation
- Duration: continued for at least 24 hours after bleeding has stopped
- Comprehensive treatment approach: includes endoscopic therapy (band ligation or sclerotherapy), careful fluid resuscitation, and prophylactic antibiotics
- Monitoring: patients should be monitored for potential adverse effects including hyperglycemia, nausea, abdominal discomfort, and bradycardia The most recent and highest quality study, published in 2024, recommends octreotide as the first-line treatment for variceal hemorrhage due to its safety profile and efficacy in controlling bleeding 1. Other vasoactive agents, such as terlipressin and vasopressin, have been shown to have similar rates of mortality and hemostasis, but have a higher risk of adverse events, including abdominal pain, chest pain, diarrhea, and hyponatremia 1. In contrast, octreotide has been shown to be less effective than terlipressin in terms of bleeding control within 24 hours, but has a lower risk of complications 1. Overall, the use of octreotide in the management of esophageal varices is supported by its safety profile and efficacy in controlling bleeding, making it the vasoactive drug of choice in this setting.
From the Research
Effect of Octreotide on Esophageal Varices
- Octreotide, a somatostatin analogue, has been shown to have a beneficial effect on portal hemodynamics in cirrhotic patients 2.
- In randomized controlled trials, octreotide has been effective in halting initial hemorrhage and preventing reoccurrence of bleeding from esophageal varices 2.
- The use of octreotide in acute variceal bleeding is recommended, with the drug being initiated immediately and continued for 2 to 5 days after endoscopic variceal ligation 2, 3.
- Octreotide can be used as a vasoactive drug to lower portal pressure in acute variceal bleeding, although the choice of drug may depend on local resources 3.
- However, some studies have shown conflicting results with regards to the effectiveness of octreotide in controlling bleeding esophageal varices, with somatostatin being more effective in some cases 4.
- Octreotide is one of several pharmacologic agents used in the management of acute esophageal variceal hemorrhage, including somatostatin, terlipressin, and vasopressin 5, 6.
- In primary and secondary prophylaxis of esophageal variceal hemorrhage, beta-blockers remain the mainstay therapy, although octreotide may be used as an adjunct to endoscopic therapy in acute bleeding 5, 6.