ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Vasopressin Analogue — Vasodilatory Shock / Variceal Bleeding Pregnancy: Terlipressin contraindicated in pregnancy (uterine contraction); vasopressin with extreme caution

Vasopressin / Terlipressin

Brand names: Pitressin (vasopressin), Glypressin (terlipressin)

Adult dose

Dose: Vasopressin: 0.01-0.04 units/min IV infusion (vasodilatory shock). Terlipressin: 1.5-2 mg IV every 4-6 hours (variceal bleeding)
Route: Intravenous
Frequency: Continuous infusion (vasopressin); every 4-6 hours (terlipressin)
Max: 0.04 units/min vasopressin; 2 mg per dose terlipressin
Vasopressin: adjunct to noradrenaline in refractory vasodilatory shock — fixed low dose (0.03 units/min) rather than titrated. Terlipressin: NICE-recommended for variceal bleeding — give with prophylactic antibiotics

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: IV
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

Use with caution — water retention risk

Hepatic

Terlipressin: use with caution; monitoring required

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • Vasopressin in septic shock: VASST trial — adding vasopressin 0.03 units/min to noradrenaline allows noradrenaline dose reduction; no overall mortality benefit but may reduce 28-day mortality in less severe shock (noradrenaline under 15 micrograms/min subgroup)
  • Terlipressin: reduces portal pressure by splanchnic vasoconstriction — first-line pharmacological treatment for oesophageal variceal bleeding alongside endoscopy; superior to placebo for 5-day haemostasis (RCT evidence)
  • MHRA: Terlipressin associated with hyponatraemia and pulmonary oedema in hepatorenal syndrome — more frequent monitoring required
  • Vasopressin must be given through central venous access — peripheral extravasation causes severe tissue necrosis
  • Hepatorenal syndrome type 1: terlipressin + albumin improves renal function and survival — NICE NG165 recommends this combination

Contraindications

  • Severe peripheral vascular disease (ischaemia risk)
  • Coronary artery disease (vasopressin — coronary vasospasm)

Side effects

  • Vasoconstriction — digital, mesenteric, coronary ischaemia
  • Hyponatraemia (water retention)
  • Bradycardia
  • Skin necrosis (extravasation)
  • Abdominal pain (terlipressin)

Interactions

  • Noradrenaline (additive vasopressor — may allow dose reduction)
  • Tricyclic antidepressants (enhanced pressor effect)

Monitoring

  • Mean arterial pressure (target above 65 mmHg)
  • Fluid balance
  • Sodium and urine output
  • Limb perfusion (peripheral ischaemia)
  • Cardiac monitoring

Reference: BNFc; BNF 90; NICE NG165 (Cirrhosis); VASST Trial; ESC Sepsis Surviving Campaign Guidelines 2021. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways