Glypressin

Indications

Terlipressin Acetate is used in hospital to treat bleeding from swollen veins in the food pipe (oesophageal varices), which happens in people with serious liver disease. It is also used to treat hepatorenal syndrome, a type of sudden kidney failure that occurs with advanced liver cirrhosis, and sometimes for other serious bleeding as decided by specialists.

How It Works

Terlipressin is a man-made form of the natural hormone vasopressin. In the body it is slowly converted into an active substance that narrows certain blood vessels, especially those supplying the gut. This lowers blood flow and pressure in the portal vein system of the liver, which helps to stop variceal bleeding, and it improves blood flow to the kidneys in hepatorenal syndrome.

Dosage and Administration

Terlipressin is given only in hospital by a doctor or nurse, as an injection or infusion into a vein. The dose, how often it is given and how long treatment lasts depend on the condition, body weight and response, and are set by the specialist. Blood pressure, heart rate, oxygen levels, fluid balance and blood salts are monitored during treatment.

Interactions

Medicines that slow the heart, such as Propranolol or Sufentanil, may increase the risk of a very slow heartbeat. Medicines that can cause irregular heart rhythm (for example some antiarrhythmics, Erythromycin, some antidepressants and antipsychotics) need caution. The medical team will review all other medicines.

Contraindications

It is not used in people allergic to Terlipressin, during pregnancy, or in septic shock with low heart output. It is avoided in people with severe breathing problems or fluid overload, and with serum creatinine already very high in hepatorenal syndrome.

Side Effects

Common effects include pale skin, stomach cramps, diarrhoea, headache, slow heartbeat, high blood pressure and reduced blood flow to the fingers or skin. Low sodium in the blood and fluid in the lungs can occur.

Tell the nurse or doctor at once about chest pain, shortness of breath, cold or blue fingers or toes, severe stomach pain, confusion or skin changes at the injection site. Serious breathing failure, heart problems and gut or skin damage from reduced blood flow can happen and are watched for closely.

Pregnancy and Lactation

Terlipressin must not be used in pregnancy because it can make the womb contract, reduce blood flow to the baby and cause miscarriage. It is not known whether it passes into breast milk; breastfeeding should be avoided during treatment.

Precautions and Warnings

Special care is needed in people with heart disease, high blood pressure, poor circulation, irregular heart rhythm, asthma or lung disease, kidney problems, low sodium or older age. Oxygen levels and fluid balance are checked often. Treatment is stopped if serious side effects develop.

Overdose

Too much may cause a sharp rise in blood pressure, a very slow heartbeat or severe narrowing of blood vessels. As it is given in hospital, the infusion would be stopped and supportive treatment given.

Therapeutic Class

Vasopressin analogue (vasoconstrictor)

Storage

Hospital medicine: store as directed on the pack, usually in a refrigerator at 2 to 8°C, do not freeze, and protect from light. Keep out of the reach of children.