Terlipressin acetate

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.