terlipressin

Contraindicated in:

Hypoxia or worsening respiratory symptoms;
Acute-on-chronic liver failure Grade 3;
Coronary, peripheral, or mesenteric ischemia;
Severe cardiovascular conditions or cerebrovascular disease, and ischemic disease;
OB: Pregnancy.

Use Cautiously in:

High prioritization for liver transplantation (adverse effects may ↑ risk of ineligibility);
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: bradycardia, edema, MYOCARDIAL ISCHEMIA, PERIPHERAL ISCHEMIA

Derm: cyanosis

GI: abdominal pain, diarrhea, nausea, GI ISCHEMIA/OBSTRUCTION

Neuro: CEREBROVASCULAR ISCHEMIA

Resp: dyspnea, respiratory failure, pleural effusion

Misc: SEPSIS

Interactions ⬆ ⬇

Drug-drug:

None reported.

Availability ⬆ ⬇

Lyophilized powder for injection: 0.85 mg/vial

Route/Dosage ⬆ ⬇

IV (Adults ): 0.85 mg every 6 hr on Days 1–3; then adjust dose as follows based on SCr starting on Day 4: ↓SCr by≥30% from baseline: Continue 0.85 mg every 6 hr until 24 hr after patient achieves 2nd consecutive SCr ≤1.5 mg/dL ≥2 hr apart or for max of 14 days. ↓SCr by<30% from baseline:↑ dose to 1.7 mg every 6 hr and continue until 24 hr after patient achieves 2nd consecutive SCr ≤1.5 mg/dL ≥2 hr apart or for max of 14 days. SCr at or above baseline: Discontinue therapy.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Simulates vasopressin receptors (V₁ more than V₂), resulting in a reduced portal hypertension and blood circulation in the portal vessels and increased mean arterial pressure.

Therapeutic effects:

Reversal of hepatorenal syndrome, including improved renal function.

Classifications ⬆ ⬇

Therapeutic Classification: hormones

Pharmacologic Classification: antidiuretic hormones

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Cleaved to active metabolite, lysine-vasopressin (terlipressin also exerts pharmacologic effects); lysine-vasopressin metabolized by peptidases in tissues. Less than 1% of terlipressin and <0.1% of lysine-vasopressin excreted in urine.

Half-Life: Terlipressin: 0.9 hr; lysine-vasopressin: 3 hr

Time/Action Profile ⬆ ⬇

(↑ in BP)

ROUTE	ONSET	PEAK	DURATION
IV	Within 5 min	1.2–2 hr	≥6 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of terlipressin. Advise patient to read Patient Information before starting therapy.
Inform patient that terlipressin-related adverse reactions (e.g., respiratory failure, ischemia) may make patient ineligible for liver transplantation, if listed.
Advise patient to immediately report symptoms of heart attack (chest pain, dyspnea, diaphoresis, dizziness, nausea), stroke (weakness, slurred speech, confusion, dizziness), and abdominal pain.
Advise patient to report difficulty breathing or distress immediately.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Rep: May cause fetal harm. Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇