Vasopressin analogue / vasopressor Pregnancy: Avoid — potent vasoconstrictor; may reduce uteroplacental blood flow.

Terlipressin

Brand names: Glypressin

Adult dose

Dose: Variceal bleeding: 1–2 mg IV bolus every 4–6 hours for up to 5 days; Hepatorenal syndrome: 0.5–1 mg every 4–6 hours

Route: IV bolus

Frequency: Every 4–6 hours

Max: 2 mg per dose

Acute variceal haemorrhage: 1–2 mg IV every 4–6 hours as soon as diagnosis suspected/confirmed (reduces portal pressure). Continue for up to 5 days (usually alongside endoscopic treatment). HRS type 1: 0.5 mg every 4–6 hours, increasing to 1–2 mg TDS if creatinine not improving.

Paediatric dose

Route: IV

Frequency: Specialist guidance

Max: Specialist guidance

Not licensed in children. Very limited paediatric data. Specialist hepatology / intensive care guidance required.

Dose adjustments

Renal

Use with caution — terlipressin causes vasoconstriction of renal vasculature. Monitor closely.

Hepatic

Standard dosing in hepatic disease (the main indication).

Clinical pearls

Start as soon as variceal bleeding suspected — before endoscopy if possible
Adjunct to emergency endoscopy with band ligation/sclerotherapy
Monitor electrolytes closely — hyponatraemia is a risk (dilutional effect)
HRS type 1: terlipressin most evidence-based pharmacological treatment (along with albumin)
Watch for peripheral ischaemia — check fingers and toes

Contraindications

Hyponatraemia (<130 mmol/L — risk of fluid retention and worsening)
Severe cardiovascular disease
Peripheral artery disease

Side effects

Hypertension (vasoconstriction)
Bradycardia
Hyponatraemia and dilutional electrolyte disturbance
Peripheral ischaemia (fingers, toes — skin necrosis)
Abdominal cramping and diarrhoea
Pulmonary oedema

Interactions

Beta-blockers — additive bradycardia
Anti-arrhythmics — QT prolongation risk

Monitoring

BP and HR every 1–2 hours
Fluid balance
U&E (sodium)
Peripheral circulation (fingers/toes)

Reference: BNFc; BNF; NICE CG141 Cirrhosis; EASL Cirrhosis and Portal Hypertension Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways