Preliminary results of synergy between norepinephrine and terlipressin during septic shock

  • Gary DuclosEmail author
  • Michel Cantaloube
  • Sophie Medam
  • Noémie Resseguier
  • Marc Leone

Dear Editor,

We congratulate Dr. Liu and colleagues for their impressive randomized clinical trial (RCT). The authors compared terlipressin and norepinephrine as first-line vasopressor in septic shock [1]. They reported a similar result in both groups. In an insightful editorial, Drs. Mårtensson and Gordon questioned the benefit of simultaneously using the two drugs, instead of monotherapy [2].

In a previous observational study, we showed that a dose of norepinephrine above 1 µg/kg/min was associated with a mortality rate above 90% [3]. As a result of this finding, we introduced terlipressin in our local protocol as standard of care in septic shock patients receiving norepinephrine above 0.5 µg/kg/min. Of note, the patients with a central venous oxygen saturation (ScvO2) below 70%, reflecting an inappropriate cardiac output, were excluded. Terlipressin was administered as an initial bolus (0.25 mg over 30 min) followed by a fixed continuous infusion (0.01 µg/kg/min), in addition to...


Compliance with ethical standards

Conflicts of interest

ML discloses conflicts of interest with Aguettant, Amomed, MSD, Octapharma Pfizer (Lectures). GD, MC, SM, and NR do not disclose any conflict of interest. GD assumes responsibility for the data.

Ethical approval

The study received the approval of our ethics committee (IRB 00010254–2018–147).

Supplementary material

134_2018_5514_MOESM1_ESM.docx (86 kb)
Supplementary material 1 (DOCX 87 kb)
134_2018_5514_MOESM2_ESM.docx (16 kb)
Supplementary material 2 (DOCX 16 kb)


  1. 1.
    Liu Z-M, Chen J, Kou Q et al (2018) Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre, randomised, double-blinded trial. Intensive Care Med 44:1816–1825. CrossRefGoogle Scholar
  2. 2.
    Mårtensson J, Gordon AC (2018) Terlipressin or norepinephrine, or both in septic shock? Intensive Care Med 44:1964–1966CrossRefGoogle Scholar
  3. 3.
    Martin C, Medam S, Antonini F et al (2015) Norepinephrine: not too much, too long. Shock 44:305–309. CrossRefGoogle Scholar
  4. 4.
    Leone M, Boyle WA (2006) Decreased vasopressin responsiveness in vasodilatory septic shock-like conditions. Crit Care Med 34:1126–1130. CrossRefGoogle Scholar
  5. 5.
    Gordon AC, Russel JA, Walley KR et al (2010) The effects of vasopressin on acute kidney injury in septic shock. Intensive Care Med 36:83–91. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Service d’Anesthésie et de Réanimation, Department of Anesthesiology and Intensive Care, Hôpital Nord, Assistance Publique Hôpitaux de MarseilleAix Marseille UniversitéMarseilleFrance
  2. 2.Support Unit for Clinical Research and Economic Evaluation, Assistance Publique Hôpitaux de MarseilleAix Marseille UniversitéMarseilleFrance
  3. 3.EA3279, Self-perceived Health Assessment Research UnitAix Marseille UniversitéMarseilleFrance

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