Terlipressin: Vasopressin Analog and Novel Drug for Septic Shock

Septic, or distributive, shock is a severe condition withan associated mortality rate around 50%.1 After vol-ume resuscitation, it typically presents as a syndrome of low systemic vascular resistance and high cardiac output.2 The goal of therapy is to raise blood pressure and maintain it at levels that provide adequate perfusion pressure to fa-cilitate oxygen delivery. Fluid resuscitation is an important component of hemodynamic management of septic shock and, ideally, should be achieved prior to initiating vaso-pressor support.3 However, following adequate fluid resus-citation, many patients continue to experience hypotension as a result of sepsis-induced impaired cardiac contractility and insufficient systemic vascular resistance.4,5 Typically, dopamine and norepinephrine are considered first-line agents in the treatment of septic shock due to the improved safety profile of these medications over other products, such as epinephrine and phenylephrine.3 Catecholamine responsiveness may decrease over time during severe sep-sis, possibly due to an increase in nitric oxide–induced va-sodilation; as a result, patients may develop septic shock that is resistant to catecholamine treatment.2,6 Vasopressin is an endogenous neurohormone that func-tions as a direct systemic vasoconstrictor independent o