Glypressin (Terlipressin Acetate)

Glypressin is indicated for the acute control of bleeding and hemodynamic support in several liver‑related and systemic conditions. It is administered by healthcare professionals in hospital settings where rapid vasoconstriction is required.

• Acute variceal bleeding associated with portal hypertension.
• Hepatorenal syndrome in patients with advanced liver disease.
• Off‑label use for septic shock when conventional vasopressors are insufficient.
• Prevention of re‑bleeding after endoscopic therapy for esophageal varices.
• Adjunctive therapy during liver transplantation to manage portal pressure spikes.

The pharmacologic action of terlipressin can produce a range of adverse effects, most of which are related to its vasoconstrictive properties.

Common

• Headache
• Nausea or vomiting
• Abdominal discomfort or cramping
• Flushing or warmth at the infusion site
• Dizziness or light‑headedness

Serious

• Ischemic complications such as myocardial infarction, peripheral limb ischemia, or intestinal ischemia
• Severe hypertension or hypertensive crisis
• Cardiac arrhythmias, including tachyarrhythmia or bradycardia
• Acute renal failure or sudden decrease in urine output

Because Glypressin induces potent vasoconstriction, several precautions should be observed before and during therapy to minimize risk.

• Assess cardiovascular status; avoid use in patients with recent myocardial infarction or uncontrolled angina.
• Monitor blood pressure and heart rate continuously during infusion.
• Use cautiously in patients with pre‑existing peripheral vascular disease or severe atherosclerosis.
• Evaluate renal function; dose adjustment may be required in acute kidney injury.
• Avoid in patients with active coronary artery disease or severe hypertension.
• Consider fetal risk; Glypressin is not recommended during pregnancy unless benefits outweigh potential risks.

Glypressin may interact with other agents that affect vascular tone, cardiac function, or renal clearance, requiring careful medication review.

Avoid

• Concurrent use of other vasopressors (e.g., norepinephrine, phenylephrine) that may cause excessive vasoconstriction.
• Strong CYP3A4 inhibitors if terlipressin metabolism is affected (though limited data, caution advised).
• Drugs that significantly increase blood pressure such as monoamine oxidase inhibitors (MAOIs) or certain antihypertensives.

Use with caution

• Beta‑blockers, which may mask tachycardia induced by terlipressin.
• Diuretics, especially loop diuretics, due to potential additive effects on renal perfusion.
• Anticoagulants, because rapid changes in portal pressure could affect bleeding risk.