Adult : IV Acute oesophageal variceal haemorrhage As powder and solvent for solution for inj: Initial: 1-2 mg, then 1 mg 4-6 hourly. Max duration: 72 hours. As solution for inj: Initial: 2 mg 4 hourly, maintain until bleeding is controlled for 24 hours or up to max of 48 hours, may reduce to 1 mg 4 hourly if needed. Hepatorenal syndrome type 1 Initial: 1 mg 6 hourly, may be increased up to max 2 mg 4-6 hourly if serum creatinine has not been reduced by at least 25% after 3 days. Max duration: 2 weeks.Terlipressin Acetate powder,Terlipressin powder
Acute oesophageal variceal haemorrhage
Adult: As powder and solvent for solution for inj: Initially, 1-2 mg, then 1 mg 4-6 hourly. Max duration of treatment: 72 hours. As solution for inj: Initially, 2 mg 4 hourly, maintain until bleeding is controlled for 24 hours or up to max of 48 hours. Subsequent doses may be reduced to 1 mg 4 hourly in patients weighing <50 kg or if adverse reaction occur.<br />Intravenous
Hepatorenal syndrome type 1
Adult: Initially, 1 mg 6 hourly via slow bolus inj, may be increased up to max 2 mg 4-6 hourly if serum creatinine has not been reduced by at least 25% after 3 days. Max duration of treatment: 2 weeks.
Powder for solution for inj: Slowly add the contents of the solvent ampoule to the powder vial and roll gently until completely dissolved. Dilute further with 10 mL NaCl 0.9% solution for inj.
Unstable angina, recent MI, septic shock with low cardiac output. Pregnancy.
Patient with uncontrolled hypertension, severe asthma or COPD, cardiac disease, arrhythmias, atherosclerosis, vascular disease (cerebral or peripheral), electrolyte and fluid disturbances. Renal impairment (especially chronic renal failure). Lactation.
Adverse Drug Reactions
Significant: QT interval prolongation, ventricular arrhythmias (including Torsade de pointes), cutaneous ischaemia and necrosis.
Cardiac disorders: Tachycardia, bradycardia, pulmonary oedema, dyspnoea.
Gastrointestinal disorders: Intestinal ischaemia, abdominal cramps, diarrhea, nausea, vomiting.
Metabolism and nutrition disorders: Rarely, hyponatraemia, hyperglycaemia.
Nervous system disorders: Convulsion, headache.
Reproductive system and breast disorders: Uterine ischaemia.
Respiratory, thoracic and mediastinal disorders: Bronchospasm, respiratory failure.
Vascular disorders: Hypertension, hypotension, pallor.
Monitor blood pressure, heart rate, serum creatinine, and electrolytes (e.g. Na/K concentrations) daily.
Symptoms: Acute hypertensive crisis, bradycardia. Management: Symptomatic and supportive treatment with a vasodilator-type α-blocker (e.g. clonidine) and atropine.
Increases the hypotensive effect of non-selective β-blockers. Concomitant use of drugs known to induce bradycardia (e.g. propofol, sufentanil) may lower heart rate and cardiac output. May trigger ventricular arrhythmias, including Torsade de pointes, when used with drugs that can prolong QT interval (e.g. class IA and III antiarrhythmics, erythromycin, certain antihistamines and TCAs), or with drugs that may cause hypokalaemia or hypomagnesaemia.
Mechanism of Action
Description: Terlipressin, an inactive prodrug, is converted via enzymatic cleavage to lysine-vasopressin. The active vasopressin selectively causes splanchnic and extrarenal vasoconstriction by stimulation of V1 receptors on vascular smooth muscle, thereby reducing splanchnic blood flow and portal pressure. It also increases systemic mean arterial pressure and decrease heart rate. It has minimal action on V2 receptors responsible for its antidiuretic effects.