Terlipressin



CLASS


  • synthetic vasopressin analogue

MECHANISM OF ACTION


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

PHARMACEUTICS


  • powder that must be mixed

DOSE


  • 1-2mg Q6 hourly

INDICATIONS


  • acute variceal bleeding
  • hepatorenal syndrome (HRS)

ADVERSE EFFECTS


  • low cardiac output state c/o vasoconstriction
  • AF
  • MI
  • heart failure
  • GI upset
  • hyponatraemia

PHARMACOKINETICS


  • Absorption
  • Distribution
  • Metabolism
  • Elimination

EVIDENCE


Variceal haemorrhage


  • Seo et al, 2014
    • In terms of mortality and re-bleeding rates, there seem to be no difference between terlipressin, somatotatin and octreotide

Hepatorenal syndrome


  • Israelsen et al, 2015 meta-analysis
    • terlipressin is more effective than placebo, and  equal with noradrenaline in efficacy
    • Terlipressin reduces mortality from Type 1 HRS

Septic shock


  • Terlipressin is not typically used for septic shock in clinical practice
  • TERLIVAP study (Morelli et al, 2009)
    • small single-center non-blinded RCT
    • terlipressin infusion was comparable to vasopressin for treatment of septic shock