Indications: bleeding from oesophageal varices.

Cautions: elderly; uncontrolled hypertension; vascular disease; heart disease; history of QT-interval prolongation; concomitant use of drugs that prolong the QT-interval; arrhythmia; respiratory disease; septic shock; electrolyte and fluid disturbances.

Contra-indications:

Renal impairment: use with caution in chronic renal failure

Pregnancy: avoid unless benefits outweigh risk—uterine contractions and increased intra-uterine pressure in early pregnancy, and decreased uterine blood flow reported.

Breast-feeding: avoid unless benefits outweigh risk—no information available.

Side Effects: abdominal cramps, diarrhoea, hypertension, hypotension, peripheral ischaemia, pallor, arrhythmia, bradycardia, headache; less commonly nausea, vomiting, hot flushes, angina, myocardial infarction, tachycardia, intestinal ischaemia, bronchospasm, respiratory failure, pulmonary oedema, convulsions, hyponatraemia; rarely dyspnea; very rarely stroke, hyperglycaemia; also reported heart failure, skin necrosis.

Dose: by intravenous injection, 2 mg every 4 hours until bleeding controlled (after initial dose, may reduce to 1 mg every 4 hours if not tolerated or body-weight under 50 kg); max. duration 48 hours.