A cirrhotic patient with bleeding oesophageal varices needs pharmacological therapy to reduce portal pressure. Which drug is the agent of choice, given its efficacy without systemic side effects?

Answer: C. Octreotide

Octreotide for variceal bleeding

Octreotide (a somatostatin analogue) is the drug of choice for pharmacotherapy of bleeding oesophageal varices - equally effective as vasopressin but with no systemic side effects.

Dosing

• A 50 microgram bolus followed by an infusion at 50-100 micrograms/hr.

The alternative (vasopressin)

• Vasopressin has ~70% success but high re-bleed rates, a risk of tissue necrosis, and must be used with caution in ischaemic heart disease.
• Combining vasopressin with GTN reduces coronary vasoconstriction and portal pressure.

Where drugs fit

1. Resuscitation.
2. Pharmacotherapy (octreotide) to lower portal pressure.
3. Endoscopic therapy (banding/sclerotherapy).
4. Balloon tamponade or TIPS for refractory bleeding.