Side by side

1. 1.Stimulates V1 receptors on vascular smooth muscle, constricting the splanchnic arterial bed.
2. 2.Lowering splanchnic inflow reduces portal pressure, which is why it is used in variceal bleeding.
3. 3.Improves effective arterial blood volume, which restores renal perfusion in hepatorenal syndrome.
4. 4.The glycine residues act as a slow-release depot, so one dose lasts hours.
5. 5.Has little V2 activity, so it does not concentrate urine the way desmopressin does.

• Hepatorenal syndrome type 1
• Acute variceal bleeding
• Refractory ascites (investigational)
• Septic shock as an adjunct vasopressor (off-label research)

• Reversal of hepatorenal syndrome in roughly a third to a half of patients when combined with albumin in trials
• Reduced portal pressure and better control of variceal bleeding
• Improved renal function markers over days
• Ischaemic complications, including skin and bowel ischaemia

• Abdominal pain and ischaemic skin necrosis
• Peripheral or gut ischaemia
• Hyponatraemia
• Fluid overload and pulmonary oedema
• Bradycardia
• Respiratory failure was reported more often than placebo in the CONFIRM trial

Research context only - a hospital medicine. In hepatorenal syndrome trials terlipressin was given as 0.85 to 1 mg intravenously every four to six hours, escalated when needed toward a maximum of about 12 mg per day, alongside albumin, for up to 14 days; variceal bleeding regimens typically use 1 to 2 mg every four to six hours for two to five days with close monitoring for ischaemia.

Research context only