terlipressin acetate: clinical use

Prescribing considerations

• Use under specialist supervision with cardiovascular, respiratory, electrolyte and fluid monitoring available.
• Assess cardiovascular, pulmonary and peripheral vascular disease, hypertension, QT-risk factors and electrolyte abnormalities where circumstances permit.
• Use particular caution in diabetes or obesity because skin ischaemia and necrosis have been reported more often in these groups.
• For hepatorenal syndrome, stabilise new or worsening respiratory disease and assess for fluid overload and infection.
• For hepatorenal syndrome, avoid use in advanced renal dysfunction or severe liver disease unless anticipated benefit outweighs risk.

Contraindications and cautions

• Pregnancy
• Hypersensitivity to terlipressin or an excipient
• Do not use in septic shock with low cardiac output

Monitoring

• Blood pressure and ECG or heart rate
• Oxygen saturation and clinical respiratory status
• Serum sodium and potassium; correct relevant electrolyte abnormalities
• Fluid balance and evidence of pulmonary congestion
• Peripheral, intestinal and cutaneous ischaemia, including the injection site
• For hepatorenal syndrome, daily assessment for infection or sepsis

Clinical pharmacology

Terlipressin is a synthetic vasopressin analogue and prodrug converted enzymatically to lysine-vasopressin. Predominantly vascular vasopressin-receptor activity causes splanchnic vasoconstriction, lowering portal venous pressure and blood flow through varices.

Formulation and product differences

• The selected product is a clear, colourless solution for intravenous injection. Confirm the exact presentation and product-specific licence because other UK formulations may differ.

Injection

Route: Parenteral

Strengths: 0.12 mg/mL, 1 mg