Glypressin (Terlipressin Acetate)

Glypressin is indicated for several acute conditions related to portal hypertension and systemic vasodilation.

• Acute variceal bleeding associated with portal hypertension.
• Hepatorenal syndrome in patients with advanced liver disease.
• Management of severe portal hypertension when endoscopic therapy is insufficient.
• Controlled hypotension during certain surgical procedures.
• Prevention of re‑bleeding after initial control of variceal hemorrhage.
• Adjunct therapy in septic shock with refractory hypotension (off‑label, clinical practice).

The safety profile of Glypressin reflects its vasoconstrictive activity; side effects are reported across a range of frequencies.

Common

• Headache, often mild and self‑limiting.
• Nausea or vomiting, usually transient.
• Transient rise in systolic blood pressure, typically resolves without intervention.
• Flushing or warmth sensation at the infusion site.

Serious

• Myocardial ischemia or infarction, especially in patients with pre‑existing coronary disease.
• Severe hypertension that may precipitate cerebrovascular events such as stroke.
• Ischemic necrosis of skin, digits or other peripheral tissues due to intense vasoconstriction.
• Cardiac arrhythmias, including ventricular tachycardia, reported in rare cases.

When prescribing Glypressin, clinicians should evaluate patient history and monitor for specific risks associated with potent vasoconstriction.

• Known cardiovascular disease (e.g., coronary artery disease, uncontrolled hypertension).
• Recent myocardial infarction or stroke.
• Peripheral vascular disease or Raynaud phenomenon.
• Severe renal impairment.
• Pregnancy and lactation status (safety not established).
• Concomitant use of other vasopressors.

Glypressin may alter the effects of other medications that influence vascular tone, cardiac function, or renal perfusion.

Avoid

• Other vasopressin analogs or potent vasoconstrictors (e.g., norepinephrine, phenylephrine).
• Monoamine oxidase inhibitors (risk of hypertensive crisis).

Use with caution

• Beta‑blockers (may mask tachycardia).
• Diuretics (potential for excessive volume depletion).
• ACE inhibitors or ARBs (altered blood pressure response).
• Antifungal azoles (possible pharmacokinetic interaction).