Vasopressin / Terlipressin

How it works

Both act as agonists at vascular V1 receptors to produce vasoconstriction independent of the adrenergic system; terlipressin is a longer-acting prodrug of lysine-vasopressin, whereas vasopressin is the native peptide given by continuous infusion.

Prescribing in practice

• Ischaemia is the shared key danger — potent vasoconstriction can cause myocardial, mesenteric, digital and skin ischaemia, so titrate carefully and avoid in uncontrolled coronary or peripheral arterial disease.
• Both can cause hyponatraemia and water retention through antidiuretic activity, so monitor sodium and fluid balance.
• Administer in a critical-care setting with continuous haemodynamic monitoring, ideally via central access for vasopressin infusions.

Monitoring

Monitor blood pressure, cardiac rhythm, serum sodium, urine output and for signs of peripheral or visceral ischaemia.

Counselling the patient

• Explain these injections support blood pressure or control bleeding by tightening blood vessels.
• Report chest or abdominal pain or colour changes in the skin, fingers or toes.

Evidence & guidelines

Use as vasopressors and, for terlipressin, in liver-related bleeding is supported by randomised trials and critical-care guidance.