Terlipressin

How it works

As a long-acting vasopressin (V1 receptor) agonist it causes splanchnic vasoconstriction, reducing portal venous inflow and pressure and improving effective circulating volume in hepatorenal syndrome.

Prescribing in practice

• Its vasoconstrictor action can precipitate myocardial, mesenteric, or peripheral ischaemia and significant hyponatraemia, so use cautiously in patients with vascular or ischaemic heart disease.
• It is used alongside endoscopic therapy and antibiotic prophylaxis in variceal bleeding rather than as sole treatment.
• Monitoring for fluid balance disturbance and electrolyte shifts, particularly sodium, is important during therapy.

Monitoring

Monitor blood pressure, heart rate, serum sodium, fluid balance, and for signs of ischaemia (cardiac, peripheral, and mesenteric) throughout treatment.

Counselling the patient

• Explain to the team that serum sodium can fall and should be checked during treatment.
• Advise reporting chest pain, abdominal pain, or peripheral colour change promptly as possible ischaemia.
• Note that terlipressin is part of a wider bleeding-control plan including endoscopy and antibiotics.

Evidence & guidelines

Terlipressin is recommended for acute variceal haemorrhage and hepatorenal syndrome in UK and international hepatology guidance, used in combination with endoscopic and antibiotic measures.