Terlipressin

Terlipressin - oesophageal varices are enlarged blood vessels that form in the stomach or oesophagus as a complication of liver disease. When administered in bleeding oesophageal varices, terlipressin (Glypressin) is broken down to release lysine vasopressin, which causes vasoconstriction of these vessels thereby reducing the bleeding. In addition, terlipressin may have a role in the treatment of hepatorenal syndrome, by increasing renal perfusion.Terlipressin can also be used in resistant septic shock, in addition to noradrenaline.

Uses
Bleeding oesophageal varices
Resistant high-output septic shock
Hepatorenal syndrome

Contraindications
Pregnancy

Administration
• Varicies
IV bolus: 2 mg, then 1–2 mg every 4–6 hourly, for up to 3 days

• Resistant high-output septic shock (unlicensed indication)
IV 0.25 mg bolus, repeated up to 4 times with 20-min intervals between doses or IV infusion (unlicensed) 0.1 mg/h (can increase to 0.3 mg/h).Will take 20 min for first effect.The infusion can be made up with 1 mg in 5 ml with the diluent provided

• Hepatorenal syndrome (unlicensed indication)
IV bolus: 0.5–1 mg 6 hourly

Reconstitute with the supplied solvent containing sodium chloride and hydrochloric acid.There is now a perparation that does not need
reconstituting but should be stored in the fridge.

Monitor: BP
Serum sodium and potassium
Fluid balance

Adverse effects
Abdominal cramps
Headache
Raised blood pressure

Cautions
Hypertension
Arrhythmias
Ischaemic heart disease

Organ failure
Renal: no dose reduction needed