Vasopressin analogue Pregnancy: Contraindicated in pregnancy. Terlipressin causes uterine contractions and increased intrauterine pressure in early pregnancy and may decrease uterine blood flow; it may have harmful effects on pregnancy and the 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 — weigh the benefit of breast-feeding against the benefit of therapy.

Terlipressin acetate

Brand names: Glypressin, Variquel

Used in: Gastrointestinal Bleeding

Terlipressin acetate is a synthetic vasopressin analogue used in the management of bleeding oesophageal varices and of hepatorenal syndrome in decompensated cirrhosis.

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: Acute variceal bleeding: initially 2 mg by intravenous injection every 4 hours

Route: Intravenous injection (must be given i.v. to avoid local necrosis at the injection site)

Frequency: Every 4 hours

Max: No maximum dose stated; maximum treatment duration for acute variceal bleeding is 48 hours

Source is the UK SPC for Terlipressin Acetate 0.12 mg/ml solution for injection (Glypressin). Treatment should be maintained until bleeding has been controlled for 24 hours, but up to a maximum of 48 hours. After the initial dose, the dose can be adjusted to 1 mg i.v. every 4 hours in patients with body weight under 50 kg or if adverse effects occur. Paediatric: 'There is no relevant use of Glypressin in paediatric population' — no paediatric dose is stated; particular caution is advised in children and the elderly as experience is limited and there is no data available regarding dosage recommendation in these groups. Monitoring during treatment: blood pressure, ECG or heart rate, oxygen saturation, serum sodium and potassium, and fluid balance. Should not be used in patients with septic shock with a low cardiac output.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Pregnancy
Hypersensitivity to terlipressin or any other excipients of the product

Side effects

Abdominal pain, nausea, diarrhoea, vomiting (most frequently reported)
Pallor, vasoconstriction, peripheral ischaemia, hypertension
Bradycardia; also tachycardia, chest pain, atrial fibrillation, myocardial infarction, torsade de pointes
Hyponatraemia
Headache
Skin necrosis unrelated to the injection site, and injection site necrosis
Pulmonary oedema, dyspnoea, respiratory failure; intestinal 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 heart rate and cardiac output
QT-prolonging medicines (class IA and III antiarrhythmics, erythromycin, certain antihistamines, tricyclic antidepressants) — terlipressin can trigger torsade de pointes; extreme caution required
Medicines that may cause hypokalaemia or hypomagnesaemia (e.g. some diuretics) — increased arrhythmia risk

Clinical monograph

How it works

It is a prodrug slowly cleaved to lysine-vasopressin, producing sustained splanchnic vasoconstriction that lowers portal pressure and variceal blood flow, and improving renal perfusion in hepatorenal syndrome by redistributing circulating volume.

Prescribing in practice

Potent vasoconstriction carries a real risk of ischaemia — myocardial, peripheral, mesenteric and cutaneous — so it is contraindicated or used with great caution in patients with significant ischaemic heart, cerebrovascular or peripheral vascular disease.
Hyponatraemia can develop rapidly owing to its antidiuretic effect; significant or symptomatic respiratory failure has been highlighted as a hazard in hepatorenal syndrome and warrants careful patient selection.
It may cause bradycardia and other arrhythmias, so cardiac monitoring is appropriate during administration.

Monitoring

Monitor blood pressure, heart rate, fluid balance, serum sodium and oxygenation, and observe the extremities for signs of ischaemia.

Counselling the patient

This is a hospital-administered injectable treatment given under close observation.
Tell staff immediately about chest pain, breathlessness or pain or colour change in the hands or feet.
Frequent monitoring of blood tests and observations is part of the treatment.

Evidence & guidelines

Terlipressin is recommended in NICE and specialist hepatology guidance for acute variceal bleeding and hepatorenal syndrome, with MHRA-flagged cautions on ischaemia and respiratory failure.

Reference: NICE CG141; UK guidelines; 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.

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