Glypressin (Terlipressin Acetate)

Glypressin is indicated for the management of acute bleeding from esophageal varices and may be employed in certain off‑label situations such as hepatorenal syndrome.

• Control of acute variceal hemorrhage in patients with portal hypertension.
• Adjunctive therapy to endoscopic treatment of bleeding esophageal or gastric varices.
• Support of systemic vascular resistance in selected cases of septic shock (off‑label).
• Management of hepatorenal syndrome in patients with advanced liver disease (off‑label).
• Temporary reduction of portal venous pressure during diagnostic or therapeutic procedures.

The safety profile of Glypressin reflects its vasoconstrictive activity, with most patients experiencing mild, transient reactions while a smaller proportion may develop serious complications.

Common

• Headache
• Nausea or vomiting
• Abdominal discomfort
• Flushing or warmth at the infusion site
• Transient hypertension

Serious

• Myocardial ischemia or infarction
• Severe hypertension with risk of stroke
• Cardiac arrhythmias
• Peripheral ischemia leading to tissue necrosis
• Acute renal failure

Before initiating Glypressin, clinicians should evaluate patient history and monitor specific parameters to minimize risk.

• Known hypersensitivity to terlipressin or vasopressin analogs.
• Pre‑existing cardiovascular disease, especially coronary artery disease.
• Uncontrolled hypertension or severe aortic stenosis.
• Active myocardial ischemia or recent myocardial infarction.
• Pregnancy and lactation status, as safety data are limited.
• Renal impairment requiring close monitoring of urine output.
• Concomitant use of vasoconstrictive agents that may amplify blood pressure effects.

Glypressin can interact with other drugs that influence vascular tone, cardiac function, or renal perfusion.

Avoid

• Other vasopressors (e.g., norepinephrine, phenylephrine) that may cause excessive vasoconstriction.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil) due to risk of severe hypotension on reversal.
• Ergot alkaloids, which can potentiate peripheral ischemia.

Use with caution

• Beta‑blockers, which may mask tachycardia.
• Diuretics, especially loop diuretics, that affect intravascular volume.
• Anticoagulants, as reduced portal pressure may alter bleeding risk.
• Calcium channel blockers, which can influence systemic vascular resistance.