Clinical use of vasopressin in the management of bleeding esophageal varices.

Vasopressin has been used for 25 years to control bleeding from esophageal varices. Its efficacy is believed to be due to a direct vasoconstrictor activity on splanchnic arterioles and precapillary sphincters, with secondary reduction in portal venous blood flow and pressure. While it has been administered by both the intra-arterial and intravenous routes, the latter has gained favor in the light of laboratory and clinical investigations. The most common complications are cardiovascular, and bradycardia is an early sign of toxicity; adverse effects may be avoided with simultaneous infusion of isoproterenol. Vasopressin has not been shown to prolong survival from esophageal bleeding. It is effective in controlling upper gastrointestinal hemorrhage and is commonly viewed as a means of buying time to prepare the patient for shunt surgery. Vasopressin infusion may reduce both operation time and blood loss during shunt surgery. New analogs of vasopressin presently under investigation may facilitate its administration and reduce morbidity.