Glypressin (Terlipressin Acetate)

Glypressin is indicated for the management of several acute vascular complications where vasoconstriction is desired.

• Treatment of acute esophageal variceal bleeding in patients with portal hypertension.
• Management of hepatorenal syndrome type 1 to improve renal perfusion.
• Off‑label use for septic shock when conventional vasopressors are insufficient.
• Control of bleeding during endoscopic or surgical procedures involving the gastrointestinal tract.
• Adjunct therapy in liver transplantation to reduce portal pressure intra‑operatively.

The safety profile of Glypressin reflects its vasoconstrictive activity; side effects are related to reduced blood flow in various vascular beds.

Common

• Headache or facial flushing due to transient vasoconstriction.
• Nausea, abdominal discomfort, or mild diarrhea.
• Elevated blood pressure or transient hypertension.
• Peripheral ischemia manifesting as cold extremities or tingling.
• Palpitations or tachycardia resulting from reflex sympathetic activation.
• Mild electrolyte disturbances, particularly hyponatremia, secondary to vasopressin activity.

Serious

• Severe hypertension with risk of cerebrovascular events.
• Cardiac arrhythmias or myocardial ischemia.
• Ischemic necrosis of skin, digits, or gastrointestinal tract.
• Acute renal failure due to severe vasoconstriction of renal arteries.
• Pulmonary edema in patients with pre‑existing cardiac dysfunction.

Glypressin should be used only under close medical supervision, with attention to conditions that may be worsened by vasoconstriction.

• Known hypersensitivity to terlipressin, vasopressin analogs, or any excipients.
• Uncontrolled hypertension or recent cerebrovascular accident.
• Active coronary artery disease or recent myocardial infarction.
• Peripheral vascular disease, including Raynaud’s phenomenon.
• Severe renal impairment or acute kidney injury.
• Pregnancy and lactation, because safety data are limited.
• Concomitant use of other potent vasoconstrictors (e.g., norepinephrine) may increase risk of ischemia.
• Patients with severe liver dysfunction should be monitored for hepatic encephalopathy.

Glypressin may interact with other agents that affect vascular tone, cardiac function, or renal perfusion, requiring dose adjustments or monitoring.

Avoid

• Concurrent use of other vasopressors (e.g., norepinephrine, phenylephrine) which can cause excessive vasoconstriction.
• Strong CYP3A4 inhibitors, although terlipressin is not primarily metabolized by CYP enzymes, they may alter plasma levels of co‑administered drugs.
• Monoamine oxidase inhibitors (MAOIs) when combined with agents that increase catecholamine release.
• Selective serotonin reuptake inhibitors (SSRIs) may increase risk of serotonin syndrome when combined with agents that raise serotonin levels.

Use with caution

• Diuretics that may exacerbate hypovolemia; monitor fluid balance and electrolytes.
• Beta‑blockers, which can mask tachycardia while vasoconstriction persists.
• Renin‑angiotensin system blockers (ACE inhibitors, ARBs) may blunt the desired hemodynamic response; dose titration may be required.