Noradrenaline versus terlipressin in the treatment of hepatorenal syndrome

Background: Various vasoconstrictors are useful in the management of hepatorenal syndrome (HRS). Terlipressin is the drug of choice; however, it is expensive. In this study, we evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of HRS. Methods: Sixty patients with HRS were managed with terlipressin (group A, N = 30) or noradrenaline (group B, N = 30) with albumin for a maximum of 15 days in a randomized controlled trial at a tertiary centre. Results: Baseline parameters were similar in both groups.HRS reversal could be achieved in 18 (60%) patients in group A and 17 (56%) patients in group B (p=0.85). Patients in both groups had a significant decrease in serum creatinine (group A, 2.36± 0.57 vs 1.33±0.41 mg/dL; group B, 2.48± 0.58 vs 1.45±0.5 mg/dL), increase in urine output (group A, 686.83±268.67 vs 1289.76±344.25 ml/24 hr; group B, 699.67±275.63 vs 1242.50±313.90 ml/24hr) and natriuresis (group A, 55.60±17.87 vs 80.45±14.87 meq/ 24 hr; group B, 51.20±15.73 vs 76.20±18.40 meq/24 hr) at day 15 (p <0.05). Nine patients in group A and 10 in group B died at day 15 (p > 0.05). Noradrenaline was less expensive than terlipressin (Rs.10400 vs 26301; p<0.05). No major adverse effects were seen. Conclusions: Noradrenaline is as safe and effective as terlipressin and less expensive than terlipressin in the treatment of HRS.