Caso clínicoSildenafil in severe peripheral ischemia induced by terlipressin. A case reportSildenafil en isquemia periférica severa inducida por tarlipresina. Reporte de un caso
Section snippets
Case report
A 51 year-old woman came to the emergency room with a history of alcoholic cirrhosis, portal hypertension, and esophageal varices (previously treated with sclerotherapy) and chronic renal failure, with her last creatinine clearance measured at 40 ml/h. She was classified as Child-Pugh C. She had presented upper digestive tract bleeding for 12 h. After 24 with persistent hemorrhage, intravenous terlipressin was added to the management (4 mg/24 h); on the third day after treatment, she developed
Discussion
Sen et al described a possible toxic effect of terlipressin related to its vasoconstrictor action.1 Terlipressin has been associated with peripheral ischaemia2 and vasculitis-like lesions, like the ones observed in this case. Sildenafil is a selective inhibitor of GMP-phosphodiesterase with an effect on microvascular and macrovascular circulation, approved for use in erectile dysfunction, pulmonary arterial hypertension, and recently described by Fries et al for use in Raynaud's phenomenon in
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Extensive cutaneous necrosis due to terlipressin use
2015, Gastroenterologia y HepatologiaCorticotrophins, corticosteroids, and prostaglandins
2014, Side Effects of Drugs AnnualCitation Excerpt :Cardiovascular In a systematic review of eight placebo-controlled studies in 320 participants with hepatorenal syndrome, there was a significant increase in the frequency of ischemic adverse events with terlipressin [90M]. In a woman who developed ischemia and necrosis of the toes after being given intravenous terlipressin, oral sildenafil 50 mg bd was rapidly effective [91A]. Takotsubo syndrome has been attributed to terlipressin in a 67-year-old man with cirrhosis and hepatorenal syndrome [92M].
The “dark” side of terlipressin: a case report of ischemic skin necrosis and review of literature
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