Gastrointestinal Emergency Pregnancy: Contraindicated in pregnancy. Terlipressin has been shown to cause uterine contractions and increased intrauterine pressure in early pregnancy and may decrease uterine blood flow; it may have harmful effects on pregnancy and foetus, and spontaneous abortion and malformation have been shown in rabbits. Breast-feeding: it is not known whether terlipressin is excreted in human breast milk and a risk to the suckling child cannot be excluded — decide whether to continue or discontinue breast-feeding or therapy taking the benefits into account.

Terlipressin

Brand names: Glypressin, Variquel

Terlipressin is a synthetic vasopressin analogue given by injection in the emergency setting, principally for bleeding oesophageal varices and for hepatorenal syndrome. This page covers its acute critical-care use.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 2 mg by intravenous injection initially (acute variceal bleeding)

Route: Intravenous injection

Frequency: Every 4 hours

Max: Treatment should be maintained until bleeding has been controlled for 24 hours, but up to a maximum of 48 hours

Indication in this SPC is acute variceal bleeding. After the initial dose, the dose can be adjusted to 1 mg i.v. every 4 hours in patients with body weight < 50 kg or if adverse effects occur. To avoid local necrosis at the injection site the injection must be given i.v. MONITORING: regular monitoring of blood pressure, ECG or heart rate, oxygen saturation, serum sodium and potassium, and fluid balance is required. Particular care in cardiovascular or pulmonary disease (terlipressin may induce ischaemia and pulmonary vascular congestion) and caution in hypertension. Should not be used in patients with septic shock with a low cardiac output. Extreme caution in patients with a history of QT interval prolongation, electrolyte abnormalities, or concomitant QT-prolonging medicines. CHILDREN AND ELDERLY: particular caution — experience is limited and 'There is no data available regarding dosage recommendation in these special patient categories'. PAEDIATRIC (non-numeric, per §4.2): 'There is no relevant use of Glypressin in paediatric population.' CROSS-LABEL WARNING: the US Terlivaz label covers a different indication (hepatorenal syndrome, 0.85 mg IV every 6 hours by slow bolus over 2 minutes) and must not be applied to variceal bleeding.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Pregnancy
Hypersensitivity to terlipressin or to any of the other excipients of the product

Side effects

Most frequently reported in clinical trials: abdominal pain, nausea, diarrhoea, pallor, vomiting and bradycardia
Cardiac: chest pain, bradycardia, tachycardia, atrial fibrillation, myocardial infarction, torsade de pointes, cardiac failure, ventricular extrasystoles
Vascular: vasoconstriction, peripheral ischaemia, pallor, hypertension, cyanosis, hot flush
Skin / administration site: skin necrosis unrelated to the site of administration; injection site necrosis
Respiratory: pulmonary oedema, dyspnoea, respiratory failure, respiratory distress
Other: hyponatraemia; headache; intestinal ischaemia; uterine hypertonus and uterine ischaemia

Interactions

Non-selective beta-blockers — the hypotensive effect on the portal vein is increased with terlipressin
Medicinal products with a known bradycardic effect (e.g. propofol, sufentanil) — may lower the heart rate and cardiac output
Medicines that prolong the QT interval (class IA and III antiarrhythmics, erythromycin, certain antihistamines, tricyclic antidepressants) — terlipressin can trigger torsade de pointes; extreme caution
Medicines that may cause hypokalaemia or hypomagnesaemia (e.g. some diuretics) — predispose to QT prolongation and torsade de pointes

Clinical monograph

How it works

It is a prodrug cleaved to lysine-vasopressin, which acts on vascular V1 receptors to cause splanchnic vasoconstriction, reducing portal venous pressure and variceal blood flow.

Prescribing in practice

Ischaemia is the key danger — intense vasoconstriction can cause myocardial, mesenteric, peripheral and skin ischaemia, so use cautiously and avoid in uncontrolled coronary or peripheral arterial disease.
Hyponatraemia can develop rapidly owing to antidiuretic activity, so monitor sodium closely.
Use with caution in arrhythmias, hypertension, asthma and during pregnancy.

Monitoring

Monitor blood pressure, heart rhythm, serum sodium, fluid balance and for signs of tissue ischaemia throughout treatment.

Counselling the patient

Explain this injection helps control bleeding by tightening blood vessels.
Report chest pain, abdominal pain or colour changes in fingers, toes or skin promptly.

Evidence & guidelines

Use in variceal bleeding and hepatorenal syndrome is supported by randomised trials and is reflected in hepatology and critical-care guidance.

Reference: BAVENO VII Consensus; CONFIRM trial NEJM 2021; 384(9):818-828; MHRA 2021 DSU; BSG Guidelines on Variceal Haemorrhage; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Octreotide · Gastrointestinal Emergency

Pathways

📚 MRCEM Revision

Featured in these MRCEM clinical pathways

Terlipressin is a core drug in the following exam-focused workups on our sister siteReviseMRCEM.

Upper GI Bleed

MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.