ADMINISTRATION ROUTES:
INTRAVENOUS
ALTERNATIVE NAMES:
Glypressin,Terlipressin Ever Pharma, Terlipressin Acetate AFT
ICU INDICATIONS:
- Acute variceal bleeding
PRESENTATION AND ADMINISTRATION:
INTRAVENOUS:
Terlipressin Ever Pharma 1 mg terlipressin acetate (equivalent to 0.85 mg terlipressin) in 5 mL
Solution is clear and colourless
Store protected from light (in original container) in a refrigerator
Note: Wellington Hospital only stocks the Terlipressin Ever Pharma brand. Other brands may be presented in different form and volume.
INTRAVENOUS:
Administer undiluted over 3 – 5 min
Line can be flushed with sodium chloride 0.9%
DOSAGE:
INTRAVENOUS:
Acute variceal bleeding
2 mg four times daily for 48 hours
Then reduce to 1 mg four times daily for up to 5 days
If bleeding has stopped after 48 hours, discontinue terlipressin.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function. Avoid in patients with severe renal dysfunction unless benefit outweighs risk.
DOSAGE IN LIVER FAILURE:
Dose as in normal liver function.
Terlipressin should be avoided in patients with severe acute-on-chronic liver failure (ACLF Grade 3) and/or Model for End-stage Liver Disease (MELD) score ≥39 unless benefit outweighs risk.
DOSAGE IN PAEDIATRICS:
Not applicable
CLINICAL PHARMACOLOGY:
- Onset of action: 2 - 5 minutes
- Duration of action: 2 - 6 hours
- Elimination: Terlipressin and its active metabolite lysine vasopressin are both cleared within 15 hours
Terlipressin is a synthetic vasopressin analogue with relative specificity for the splanchnic circulation where it causes vasoconstriction. This reduces blood flow through these vessels with a reduction in portal pressure.
CONTRAINDICATIONS:
- Hypersensitivity to terlipressin
- Ongoing coronary, peripheral or mesenteric ischaemia
- Hypoxia or worsening respiratory symptoms
- Pregnancy
WARNINGS:
Cardiovascular disease:
Avoid use in patients with a history of severe cardiovascular conditions, cerebrovascular disease, or ischaemic disease, as terlipressin may cause ischaemic events.
Low cardiac output:
Due to its profound vasoconstrictor effects, terlipressin may lead to reduced cardiac output secondary to increased afterload, particularly in the setting of underlying reduced left ventricular function.
Liver transplant candidates:
Terlipressin-related adverse reactions (respiratory failure, ischaemia) may make a patient ineligible for liver transplantation, if listed. Evaluate the benefits versus the risks of terlipressin therapy in these patients.
PRECAUTIONS:
General:
See WARNINGS
Laboratory Tests:
No laboratory tests are required in addition to routine ICU monitoring
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
Concomitant treatment with drugs with a known bradycardic effect may lower the heart rate and cardiac output.
Terlipressin may increase the hyponatremic effects of desmopressin.
ADVERSE REACTIONS:
General:
Injection site necrosis
Cardiovascular:
Bradycardia, atrial fibrillation, ventricular extrasystoles, tachycardia, myocardial infarction, cardiogenic shock, prolonged QT interval and torsade de pointes, left ventricular failure, peripheral vasoconstriction, peripheral ischaemia, hypertension, intestinal ischaemia, peripheral cyanosis, hot flushes
Respiratory:
Dyspnoea, pleural effusion, pulmonary oedema, respiratory distress, respiratory failure
Neurological:
Headache
Gastrointestinal:
Abdominal pain, nausea, vomiting, diarrhoea, intestinal ischaemia and necrosis
Infection:
Sepsis, septic shock
Dermatological:
Gangrene of skin and/or subcutaneous tissues
Musculoskeletal:
Rhabdomyolysis
Metabolic and Endocrine:
Hyponatraemia, hypervolemia
Reproductive system and breast disorders:
Uterine ischaemia