Terlipressin

Class
Antidiuretics
Subclass
Vasopressin analogs
Substance name
Terlipressin
Brand names
Terlivaz®
Common formulations
Powder for parenteral solution
Dosage and administration
Adults patients
Hepatorenal syndrome
Start at: 0.85 mg IV q6h, administered over 2 minutes, for 3 days
Maintenance: 0.85-1.7 mg IV q6h, administered over 2 minutes, until normalization of serum creatinine (two consecutive serum measurements ≤ 1.5 mg/dL at least 2 hours apart) or for a maximum of 14 days
Increase to 1.7 mg intravenously QID on day 4 if serum creatinine has not decreased by ≥ 30% from baseline. Discontinue if serum creatinie is at or above baseline.
Variceal hemorrhageOff-label
Start at: 2 mg IV q4h until control of bleeding
Maintenance: 1 mg IV q4h for 2-5 days
Indications for use
Labeled indications
Adults
Treatment of hepatorenal syndrome
Off-label indications
Adults
Treatment of variceal hemorrhage
Safety risks
Boxed warnings
Respiratory failure
Maintain a high level of suspicion, as terlipressin may cause serious or fatal respiratory failure. Obtain baseline oxygen saturation and monitor respiratory status with continuous pulse oximetry. Use caution in patients with with fluid overload. Avoid use in patients with acute-on-chronic liver failure grade 3. Do not use in patients with hypoxia or worsening respiratory symptoms.
Contraindications
Coronary, peripheral, or mesenteric ischemia
Hypoxia or worsening respiratory symptoms
Warnings and precautions
Ineligibility for liver transplant
Use caution in patients listed for liver transplantation, as terlipressin-related adverse reactions (respiratory failure, ischemia) may affect eligibility. Weigh the benefits and risks for patients with high prioritization for liver transplantation.
Ischemic events
Maintain a high level of suspicion, as terlipressin may cause cardiac, cerebrovascular, peripheral, or mesenteric ischemia. Avoid use in patients with a history of severe cardiovascular conditions, cerebrovascular and ischemic disease.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
Monitor serum creatinine. Adjust subsequent doses based on the response to initial doses. Continue at 0.85 mg IV QID if serum creatinine has decreased by ≥ 30% from baseline on day 4. Increase to 1.7 mg IV QID on day 4 if serum creatinine has decreased by < 30% from baseline. Discontinue if serum creatinie is at or above baseline. Patients with a serum creatinine > 5 mg/dL are unlikely to experience benefit.
Renal replacement therapy
Any modality
No guidance available.
Hepatic impairment
Any severity
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: D
Avoid use. Evidence of fetal harm in humans. Terlipressin induces uterine contractions and endometrial ischemia.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
Abdominal pain, diarrhea, dyspnea, nausea, respiratory failure
Common 1-10%
Bradycardia, fluid retention, ischemic events, intestinal ischemia, pleural effusion, sepsis, skin discoloration, cyanosis
Unknown frequency
Headache, gangrene, skin necrosis, ↓ serum sodium
Interactions
Drug(s)
Check Interactions
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