Terlipressin Ischaemic Risk — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGastroenterology & HepatologyTerlipressin Ischaemic RiskRACP Adult Medicine

A 60-year-old man with decompensated cirrhosis (Child-Pugh C) and hepatorenal syndrome is commenced on terlipressin infusion plus albumin. His creatinine begins to improve. What adverse effect of terlipressin must be closely monitored?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Nephrotoxicity

Terlipressin causes splanchnic vasoconstriction (its therapeutic mechanism) but also constricts other vascular beds, causing peripheral (digital) and visceral (mesenteric, coronary) ischaemia. The CONFIRM trial identified ischaemic events (bowel ischaemia, cardiac ischaemia, digital gangrene) as important adverse effects. Patients on terlipressin require close monitoring for: abdominal pain (mesenteric ischaemia), chest pain/ECG changes (coronary ischaemia), and digital pallor/cyanosis. Terlipressin should be ceased immediately if ischaemic signs develop. GTN patches may be applied to reduce peripheral ischaemia.

Reference: eTG – 2025 – Gastrointestinal; CONFIRM Trial – 2022