Vasopressin Analogue
Pregnancy: Contraindicated — vasoconstrictive effects on placenta
Terlipressin
Brand names: Glypressin
Adult dose
Dose: Oesophageal variceal haemorrhage: 2 mg IV bolus every 4–6 hours for up to 5 days. Hepatorenal syndrome: 0.5–2 mg IV every 4–6 hours.
Route: IV slow bolus
Frequency: Every 4–6 hours
Max: 2 mg per dose
For acute variceal haemorrhage (use with broad-spectrum antibiotics and terlipressin together with endoscopy). For hepatorenal syndrome type 1: terlipressin + albumin.
Paediatric dose
Dose: 0.05 mg/kg
Route: IV slow bolus over 1 minute
Frequency: Every 4–6 hours
Max: 2 mg per dose
Concentration: 1 mg/5 mL or 0.2 mg/mL mg/ml
Off-label paediatric use: 0.05 mg/kg (max 2 mg) IV every 4h for variceal bleeding. Specialist hepatology only.
Dose adjustments
Renal
Caution — may exacerbate renal impairment in some settings. In HRS: aim to improve renal function.
Hepatic
No dose adjustment required; main indication is in hepatic disease
Paediatric weight-based calculator
Off-label paediatric use: 0.05 mg/kg (max 2 mg) IV every 4h for variceal bleeding. Specialist hepatology only.
Clinical pearls
- ATLAS study: terlipressin superior to vasopressin for variceal haemorrhage with better safety profile
- For hepatorenal syndrome: terlipressin + 20% albumin (1 g/kg day 1 then 20–40 g/day) is standard — CONFIRM trial
- Monitor ECG and BP closely — peripheral ischaemia can be severe, especially in vascular disease
- Start alongside ceftriaxone 1 g/day prophylaxis for SBP in acute variceal bleeding (Baveno guidelines)
Contraindications
- Ischaemic heart disease or peripheral vascular disease (strong relative)
- Pregnancy
- Severe asthma or bronchospasm
- Epilepsy
Side effects
- Pallor (cutaneous vasoconstriction)
- Abdominal cramps
- Hypertension
- Bradycardia
- Peripheral ischaemia
- Myocardial ischaemia
- Hyponatraemia (water retention)
Interactions
- Beta-blockers — additive bradycardia
- QT-prolonging drugs — increased risk
- Non-selective NSAIDs — impair renal function
Monitoring
- Blood pressure and heart rate
- ECG (ischaemia, arrhythmia)
- Peripheral perfusion
- Urine output (in HRS: target improvement in creatinine)
- Sodium levels
Reference: BNFc; BNF; Baveno VII Consensus 2022; CONFIRM Trial (Wong et al, NEJM 2021). Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs