Drug reference

Terlipressin

Vasopressin analogue (prodrug of lysine-vasopressin) · Hemostatic

Also known as Terlipressin Acetate, Glypressin

START

HRS-1: 1 mg IV q6h with albumin, titrate by creatinine response

TYPICAL MAX

~2 mg q6h (HRS); variceal up to 2 mg q4h

STOP IF

Ischaemic event, respiratory compromise, severe hyponatraemia, no renal response by day 4

WATCH

SpO2/respiratory status, ECG, sodium, signs of ischaemia, fluid balance

CDSCO approvedATC H01BA04

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 15min · haemodynamic onset
PEAK: 1.5h · active metabolite peak
t½: 42min · terlipressin t½
DURATION: 5h · effect duration

EXCRETION

Peptidase cleavage; renal metabolites

route + CYP

INTERACTIONS

1 major

SEVERE in our sources

PREGNANCY

Avoid unless life-threatening — uterotonic/ischaemic risk; limited data

FDA category + note

Top interactionssee all 5 →

Qt ProlongingSevereDatabaseKimi deep-research + Cla

Available in India

51 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Synthetic vasopressin analogue cleaved to lysine-vasopressin; V1-receptor agonism causes splanchnic vasoconstriction (reduced portal pressure/flow) and systemic vasopressor effect; longer-acting than vasopressin.

Indications

Hepatorenal syndrome type 1 (with albumin)Bleeding oesophageal varicesVasodilatory/septic shock (off-label, ICU)

Dosing

Adult: HRS-1: 0.85–1 mg IV every 6 h (titrate to ~2 mg q6h by response/creatinine), with albumin. Variceal bleeding: 2 mg IV q4h until control then 1 mg q4h up to 5 days.
Pediatric: Not established (specialist only).
Renal adjustment: No formal mg adjustment; HRS dosing is creatinine-response-guided.
Hepatic adjustment: No specific adjustment; used in advanced liver disease with monitoring.
Geriatric: Greater ischaemic risk; cautious use, monitor.
Max dose: ~12 mg/day (e.g. 2 mg q4h variceal); HRS commonly ≤2 mg q6h

Pharmacokinetics

Onset

Minutes (BP/portal pressure)

Peak effect

~1–2 h (active lysine-vasopressin)

Duration

~4–6 h (long-acting)

Half-life

Terlipressin ~40 min; active metabolite longer

Bioavailability

IV 100%

Protein binding

Low

Metabolism

Endo/exopeptidase cleavage to lysine-vasopressin

Excretion

Renal (metabolites); little unchanged

Contraindications

Hypersensitivity to terlipressin
Caution/relative: significant ischaemic cardiovascular/cerebrovascular/peripheral vascular disease, uncontrolled sepsis with hypoxia