Monograph: |
Terlipressin
Adverse Effects, Treatment, and Precautions
As for Vasopressin.
The pressor and antidiuretic effects of terlipressin are report-
ed to be less marked than those of vasopressin.
Effects on electrolytes. A report of hypokalaemia in a pa-
tient receiving terlipressin.
Uses and Administration
Terlipressin is an inactive prodrug which is slowly converted
in the body to lypressin. and has the general physiological ac-
tions of vasopressin .
It is used in the control of bleeding oesophageal varices in
doses of 2 mg by intravenous injection, followed by I or 2 mg
every 4 to 6 hours if necessary, until bleeding is controlled,
for up to 72 hours.
The acetate has been used similarly.
Variceal haemorrhage. In a study in patients with bleed-
ing oesophageal varices, patients responded better to
terlipressin given by intravenous bolus injection than to vaso-
pressin given by intravenous infusion. There was no signifi-
cant difference in mortality between the two drugs. A
placebo-controlled study in patients with confirmed or sus-
pected cirrhosis of the liver showed that terlipressin was ef-
fective in controlling variceal bleeding and that significantly
fewer patients receiving terlipressin died from bleeding or
secondary hepatic failure than those receiving placebo. Early
administration of terlipressin and glyceryl trinitrate (before
endoscopy) has also been shown to reduce bleeding and mor-
tality rates in cirrhotic patients with active upper gastro-intes
tinal bleeding. Comparison of a regimen of terlipressin given
by intravenous bolus injection, plus glyceryl trinitrate given
sublingually, with balloon tamponade in variceal bleeding
suggested similar efficacy. However, tamponade was suc-
cessful in all patients that were previously unresponsive to
terlipressin plus glyceryl trinitrate whereas this drug combi-
nation failed in all patients previously unresponsive to tam-
ponade.
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