Terlipressin

Terlipressin

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Glypressin

ICU INDICATIONS:

  1. Acute variceal bleeding

PRESENTATION AND ADMINISTRATION:

  • IV: Glypressin lyophilized powder is provided in a 6ml glass vial with a rubber stopper and green/silver coloured snap cap. Each vial of powder contains 1mg terlipressin acetate. The diluent is provided in a 5ml glass ampoule. Substance and diluent are provided together. Mix solvent with powder for injection via the rubber stopper in the vial. The clear reconstituted solution must be injected intravenously immediately after reconstitution.
    Store at room temperature

DOSAGE:

  • IV: Terlipressin is administered as an IV bolus 6-hourly. For acute variceal bleeding, the dose is 2mg 6 hourly for the first 24 hours, reducing to 1mg 6 hourly for the second 24 hours if bleeding has stabilised. If bleeding has ceased after 48 hours then Terlipressin can be stopped.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • No data available

DOSAGE IN PAEDIATRICS:

  • Not applicable

CLINICAL PHARMACOLOGY:

  • Terlipressin is a synthetic vasopressin analogue with relative specificity for the splanchnic circulation where it causes vasoconstriction in these vessels with a reduction in portal pressure.

CONTRAINDICATIONS:

  1. hypersensitivity to terlipressin
  2. pregnancy

WARNINGS

  • Low cardiac output: Due is its profound vasoconstrictor effects, terlipressin may lead to reduced cardiac output secondary to increased afterload particularly in the setting of underlying reduced left ventricular function

PRECAUTIONS

  • General: See WARNINGS
  • Laboratory Tests: No tests additional to routine ICU tests are required
  • Drug/Laboratory Test Interactions: None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Concomitant treatment with medicinal products with a known bradycardic effect may lower the heart rate and cardiac output.

ADVERSE REACTIONS

  • Neurological: Headache
  • Cardiovascular: Bradycardia, atrial fibrillation, ventricular extrasystoles, tachycardia, chest pain, myocardial infarction, fluid overload with pulmonary oedema, torsade de pointes, left ventricular failure, peripheral vasoconstriction, peripheral ischaemia, hypertension, intestinal ischaemia, peripheral cyanosis
  • Respiratory: Respiratory distress, respiratory failure
  • Gastrointestinal: Abdominal pain, nausea, vomiting, diarrhoea
  • Metabolic and Endocrine: Hyponatraemia

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