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

Brand names: Glypressin

Terlipressin is a vasopressin analogue used to control acute variceal bleeding in portal hypertension and to treat hepatorenal syndrome.

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

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. US CROSS-CHECK (different indication and regimen — do not merge): the US product TERLIVAZ is labelled for hepatorenal syndrome at 0.85 mg (1 vial) intravenously every 6 hours by slow IV bolus over 2 minutes on Days 1-3, with Day 4 adjustment against baseline serum creatinine (continue 0.85 mg every 6 hours if SCr has fallen by at least 30%; increase to 1.7 mg every 6 hours if it has fallen by less than 30%; discontinue if SCr is at or above baseline), continued until 24 hours after two consecutive SCr values of 1.5 mg/dL or less taken at least 2 hours apart, or a maximum of 14 days.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — 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

Acting on vascular vasopressin receptors, it causes splanchnic vasoconstriction that reduces portal venous pressure and bleeding, and improves renal perfusion in hepatorenal syndrome.

Prescribing in practice

Its vasoconstrictor action can cause myocardial, peripheral, and mesenteric ischaemia, so use with caution and avoid in patients with significant ischaemic vascular disease.
It can cause hyponatraemia and fluid disturbance, so monitor serum sodium during treatment.
Respiratory and circulatory adverse effects have been reported in hepatorenal syndrome, requiring close clinical observation.

Monitoring

Monitor blood pressure, heart rate, fluid balance, serum sodium, and for signs of ischaemia throughout treatment.

Counselling the patient

This is a hospital treatment given to control bleeding and support kidney function.
Tell staff immediately about chest pain, breathlessness, or pain in the limbs or abdomen.

Evidence & guidelines

Terlipressin combined with antibiotic prophylaxis is established practice for acute variceal haemorrhage and type 1 hepatorenal syndrome.

Reference: Baveno VII Consensus 2022; CONFIRM Trial (Wong et al, NEJM 2021); 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.

Drugs

Pathways