Vasopressin Analogue Pregnancy: C

Terlipressin (Vascular)

Brand names: Glypressin, Variquel

Adult dose

Dose: 1–2 mg IV bolus every 4–6 hours (oesophageal varices); 0.8–1.3 mg/h continuous infusion

Route: slow IV injection or infusion

Frequency: every 4–6 hours or continuous

Max: 2 mg per bolus

Used for variceal haemorrhage and hepatorenal syndrome; continue for up to 5 days; reduces portal pressure via splanchnic vasoconstriction

Paediatric dose

Dose: 20 micrograms/kg

Route: IV

Frequency: every 4–6 hours

Max: 1 mg per dose

Concentration: 1 mg/5 mL reconstituted micrograms/ml

Limited paediatric data; specialist use only for variceal haemorrhage

Dose adjustments

Renal

Use with caution in severe renal impairment

Hepatic

Use with caution; main indication is hepatic pathology

Paediatric weight-based calculator

Patient weight (kg)

Limited paediatric data; specialist use only for variceal haemorrhage

Clinical pearls

CONFIRM trial: terlipressin improves 90-day survival in hepatorenal syndrome type 1
Splanchnic vasoconstriction reduces portal blood flow — effective bridging to endoscopy/TIPS
Contraindicated in septic shock — may cause dangerous systemic hypertension and tissue ischaemia

Contraindications

Ischaemic heart disease
Hypertension
Peripheral vascular disease
Septic shock
Asthma (bronchoconstriction)

Side effects

Hypertension
Pallor
Abdominal cramps
Diarrhoea
Bradycardia
Ischaemia (cardiac, digital, splanchnic)
Hyponatraemia

Interactions

Beta-blockers (bradycardia)
Drugs prolonging QT

Monitoring

Blood pressure
ECG (ischaemia monitoring)
Serum sodium
Urine output (HRS)

Reference: BNFc; BNF 86; CONFIRM trial; BSG variceal haemorrhage guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

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