Terlipressin
Also known as: Glypressin, INN: terlipressin, Lysine vasopressin prodrug, Terlipressine, Terlivaz, TLP, Triglycyl-lysine-vasopressin
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Summary
Terlipressin is a synthetic vasopressin analogue used intravenously to treat hepatorenal syndrome and acute variceal bleeding by inducing potent vasoconstriction via V1‑receptor activation.
Mechanism of Action
Prodrug that is enzymatically converted to lysine vasopressin, selectively activates V1 receptors causing systemic vasoconstriction, increased mean arterial pressure, and reduced portal venous pressure
Routes of Administration
Goals & Uses
- Acute variceal bleedingGastrointestinalHigh
- Prevention of post-hepatectomy liver failureSurgical/HepaticLow
- Esophageal variceal bleeding controlGastroenterology/HemostasisHigh
- Hepatorenal syndromeRenalHigh
- Septic shock (off‑label)Critical CareModerate
- Gastric variceal bleedingGastroenterology/HemostasisModerate
- Hepatorenal syndrome type 1 (HRS-1) treatmentRenal/HepaticHigh
- Septic shock (vasopressor support)Critical CareModerate
Contraindications
- Respiratory failure / hypoxiaPulmonaryHigh
- Ischemic heart diseaseCardiovascularModerate
- Hyponatremia (severe)Metabolic/ElectrolyteModerate
- PregnancyPopulationHighPotential fetal risk or insufficient safety data
- Sepsis with high output statesInfectious/Critical CareModerate
- Peripheral arterial occlusive diseaseVascularHigh
- Uncontrolled hypertensionCardiovascularModerate
- Known hypersensitivity to terlipressinAllergyHigh
- Severe cardiovascular disease / ischemic heart diseaseCardiovascularHigh
Adverse Effects
- Myocardial infarctionCardiovascularRare
- HypertensionCardiovascularCommonHigh blood pressure
- Peripheral ischemiaVascularUncommon
- Respiratory failure / pulmonary edemaPulmonaryUncommon
- Abdominal cramps / painGastrointestinalCommon
- Abdominal cramps / diarrheaGastrointestinalCommon
- Peripheral ischemia / skin necrosisVascularUncommon
- Bradycardia / cardiac arrhythmiaCardiovascularUncommon
- HyponatremiaElectrolyteCommon
Drug Interactions
- NitroglycerinModerate
- Beta-blockersModerate
- Drugs prolonging QT intervalModerate
- NSAIDsModerateMay increase renal risk in susceptible patients
- Vasopressors (norepinephrine, vasopressin)High
- Other vasoconstrictors (e.g., norepinephrine)High
Population Constraints
- PregnancyReproductive SafetyRelative
- Pediatric patientsAgeRelative
- ElderlyAgeRelative
- Patients with severe hyponatremia (Na < 130 mEq/L)MetabolicRelative
- Elderly patientsAgeRelative
- Pregnant womenReproductiveAbsolute
- Patients with hypoxia or respiratory compromisePulmonaryAbsolute
Regulatory Status
- European UnionApprovedApproved: hepatorenal syndrome, acute variceal bleedingMarketing authorization granted; prescription only
- United StatesUnapprovedInvestigational use under IND for hepatorenal syndrome; not FDA‑approved
- United KingdomApprovedApproved: hepatorenal syndrome, acute variceal bleedingAuthorized via MHRA; prescription only
Not approved by the US FDA; approved in the European Union, United Kingdom, Japan, and several Asian countries for hepatorenal syndrome and variceal hemorrhage.
Evidence & Sources
No sources recorded yet.
Frequently Asked Questions
What is Terlipressin?
Terlipressin is a synthetic vasopressin analogue used intravenously to treat hepatorenal syndrome and acute variceal bleeding by inducing potent vasoconstriction via V1‑receptor activation.
What is Terlipressin used for?
Terlipressin is educationally associated with: Acute variceal bleeding, Prevention of post-hepatectomy liver failure, Esophageal variceal bleeding control, Hepatorenal syndrome, Septic shock (off‑label), Gastric variceal bleeding, Hepatorenal syndrome type 1 (HRS-1) treatment, Septic shock (vasopressor support). Educational only — not medical advice.
How is Terlipressin administered?
Recorded routes of administration: Intramuscular, Intravenous, Subcutaneous.
What are the potential side effects of Terlipressin?
Reported adverse effects include: Myocardial infarction, Hypertension, Peripheral ischemia, Respiratory failure / pulmonary edema, Abdominal cramps / pain, Abdominal cramps / diarrhea, Peripheral ischemia / skin necrosis, Bradycardia / cardiac arrhythmia, Hyponatremia. This list is not exhaustive — consult a qualified clinician.
Who should avoid Terlipressin?
Recorded contraindications: Respiratory failure / hypoxia, Ischemic heart disease, Hyponatremia (severe), Pregnancy, Sepsis with high output states, Peripheral arterial occlusive disease, Uncontrolled hypertension, Known hypersensitivity to terlipressin, Severe cardiovascular disease / ischemic heart disease. Consult a qualified clinician before use.