Outpatient Terlipressin Infusion for the Treatment of Refractory Ascites.

Although most patients with cirrhosis complicated by ascites initially respond to salt restriction and diuretics, as their liver disease progresses many lose diuretic responsiveness and develop refractory ascites, a condition for which there is no established drug treatment. Terlipressin is a synthetic analogue of vasopressin that causes splanchnic vasoconstriction, consequently improving renal blood flow and kidney function, and thus may ameliorate many of the pathophysiological changes that result in ascites formation. Its short half-life and bolus dose administration have previously precluded its long term use to treat ascites or other complications of cirrhosis. We performed a 4 week prospective trial of outpatient continuous terlipressin infusion in 5 patients with refractory ascites to examine its safety, practicality and efficacy in reducing ascites formation.