terlipressin

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

Contraind./Precautions ⬆ ⬇

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.

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.

Availability ⬆ ⬇

Lyophilized powder for injection: 0.85 mg/vial

Assessment ⬆ ⬇

Assess cardiac history and ECG at baseline.
Obtain baseline oxygen saturation before starting therapy and monitor patients for hypoxia using continuous pulse oximetry during treatment. Discontinue terlipressin if oxygen satuation <90%. Do not resume terlipressin until hypoxia resolves.
Monitor for signs and symptoms of ischemia such as MI (chest pain, dyspnea, diaphoresis, dizziness, nausea), stroke (weakness, slurred speech, confusion, dizziness), and GI ischemia (abdominal pain, constipation, obstruction).
Monitor daily weight, respiratory status, and volume status, and assess patient routinely for fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention) and signs and symptoms of respiratory failure (dyspnea, tachypnea, pallor, cyanosis, Cheyne-Stokes respiration, altered level of consciousness, confusion). Dose interruption or adjustment or discontinuation may be required.

Lab Test Considerations:

Obtain baseline serum creatinine value prior to treatment initiation and then on Day 4 to adjust dose.

Implementation ⬆ ⬇

IV Administration:

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.

Evaluation/Desired Outcomes ⬆ ⬇

Reversal of hepatorenal syndrome, including improved renal function.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

32861- Chengdu Shengnuo Biopharm Co. Ltd.
- 32861-0012-
  - 32861-0012-1- 100 g in 1 BAG (32861-0012-1)

41701- Hemmo Pharmaceuticals Pvt. Ltd
- 41701-009-
  - 41701-009-08- 1 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC (41701-009-08) / 10 g in 1 BOTTLE, PLASTIC (41701-009-07)

41701- Piramal Pharma Limited
- 41701-016-
  - 41701-016-02- 1 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC (41701-016-02) / 6 g in 1 BOTTLE, PLASTIC (41701-016-01)

43825- Mallinckrodt Hospital Products Inc.
- 43825-200- Terlivaz
  43825-200-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (43825-200-01) / 5 mL in 1 VIAL, SINGLE-DOSE

58862- Polypeptide Laboratories San Diego, LLC
- 58862-0179-
  - 58862-0179-1- 10 g in 1 BOTTLE, GLASS (58862-0179-1)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-1- 4 g in 1 BOTTLE, GLASS (63586-0124-1)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-2- 8 g in 1 BOTTLE, GLASS (63586-0124-2)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-3- 30 g in 1 BOTTLE, GLASS (63586-0124-3)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-4- 60 g in 1 BOTTLE, GLASS (63586-0124-4)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-5- 125 g in 1 BOTTLE, GLASS (63586-0124-5)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-6- 250 g in 1 BOTTLE, GLASS (63586-0124-6)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-7- 500 g in 1 BOTTLE, GLASS (63586-0124-7)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-8- 1000 g in 1 BOTTLE, GLASS (63586-0124-8)

63586- PolyPeptide Laboratories (Sweden) AB
- 63586-0124-
  63586-0124-9- 4000 g in 1 BOTTLE, GLASS (63586-0124-9)

68225- Patheon Italia S.p.A.
- 68225-257-
  68225-257-00- 117 VIAL, SINGLE-DOSE in 1 TRAY (68225-257-00) / 5 mL in 1 VIAL, SINGLE-DOSE

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇