From the Guidelines
Terlipressin is primarily indicated for the treatment of hepatorenal syndrome type 1 (HRS-1) and is also used for managing variceal bleeding in patients with portal hypertension due to cirrhosis, with a recommended dosing regimen of 1 mg intravenously every 6 hours for HRS-1 and 2 mg intravenously every 4 hours for variceal bleeding, as supported by recent guidelines and studies 1.
Indications for Terlipressin
The main indications for terlipressin are:
- Hepatorenal syndrome type 1 (HRS-1), a severe form of acute kidney injury in patients with advanced liver disease
- Variceal bleeding in patients with portal hypertension due to cirrhosis
Dosing Regimen
The typical dosing regimen for terlipressin is:
- For HRS-1: 1 mg intravenously every 6 hours, which can be increased to 2 mg every 6 hours if serum creatinine does not decrease by at least 30% after 3 days
- For variceal bleeding: 2 mg intravenously every 4 hours for the first 48 hours, followed by 1 mg every 4 hours for up to 5 days
Mechanism of Action
Terlipressin works as a vasopressin analog that causes splanchnic vasoconstriction, reducing portal pressure while improving renal perfusion by redistributing blood flow from the splanchnic to the systemic circulation, thereby improving kidney function in patients with HRS-1 and reducing bleeding from esophageal varices.
Monitoring and Adverse Effects
Patients should be monitored for potential adverse effects including ischemic complications, cardiac arrhythmias, and hyponatremia, as reported in studies 1.
Recent Guidelines and Studies
Recent guidelines and studies support the use of terlipressin for HRS-1 and variceal bleeding, with a focus on careful patient selection and monitoring to minimize adverse effects 1.
From the FDA Drug Label
TERLIVAZ is a vasopressin receptor agonist indicated to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function. The indications for terlipressin are to:
- Improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function 2 Limitation of Use: Patients with a serum creatinine >5 mg/dL are unlikely to experience benefit 2
From the Research
Indications for Terlipressin
- Terlipressin is used in the treatment of patients with cirrhosis and bleeding esophageal varices (BEV) 3, 4, 5
- It is also used in patients with hepatorenal syndrome (HRS), a form of renal failure seen in patients with cirrhosis 3, 4, 6
- Terlipressin has beneficial effects in the treatment of norepinephrine-resistant septic shock 4
- The use of terlipressin reduces the portal vein pressure and decreases the pressure in esophageal varices, which can save lives when skilled endoscopists are not immediately available 4
Mechanism of Action
- Terlipressin exerts its main pharmacological effect through stimulation of vasopressin-1 receptors, which are located in vascular smooth muscle and mediate vasoconstriction 3
- In patients with cirrhosis and portal hypertension, treatment with terlipressin increases mean arterial pressure and decreases portal flow and pressure within minutes of administration 3
Efficacy and Safety
- Terlipressin decreases failure of initial hemostasis by 34%, decreases mortality by 34%, and is considered a first-line treatment for BEV, when available 3, 5
- Terlipressin in combination with albumin reverses type 1 HRS in 33%-60% of cases and is the only treatment with proven efficacy in randomized trials 3
- Adverse events are mostly cardiovascular and related to vasoconstriction, with mild adverse events related to terlipressin treatment occurring in 10%-20% of patients 3
- Ischemic adverse events, such as skin necrosis, are rarely observed, but can occur in patients treated with terlipressin 7, 6