Glypressine (Terlipressin)

Glypressine is indicated for several serious clinical situations where vasoconstriction can improve outcomes.

• Management of hepatorenal syndrome in patients with advanced liver disease.
• Control of acute variceal bleeding associated with portal hypertension.
• Adjunctive therapy for septic shock when conventional vasopressors are insufficient.
• Off‑label use in selected cases of refractory hypotension under specialist guidance.

The safety profile of Glypressine reflects its potent vasoconstrictive activity, with side effects ranging from mild to severe.

Common

• Headache or facial flushing.
• Nausea, vomiting, or abdominal discomfort.
• Transient hypertension or increase in blood pressure.
• Peripheral edema or swelling of extremities.

Serious

• Severe hypertension leading to hypertensive crisis.
• Cardiac arrhythmias or myocardial ischemia.
• Ischemic complications such as digital necrosis.
• Acute renal impairment or worsening kidney function.

Because Glypressine produces marked vasoconstriction, careful patient selection and monitoring are essential before and during therapy.

• Assess cardiovascular status, especially history of ischemic heart disease.
• Monitor blood pressure frequently to detect excessive rises.
• Evaluate renal function and fluid balance prior to infusion.
• Use caution in patients with active gastrointestinal bleeding.
• Avoid in uncontrolled hypertension or severe aortic stenosis.
• Consider pregnancy status; safety data are limited.

Glypressine can interact with other agents that affect vascular tone or renal perfusion, requiring attention to concurrent medications.

Avoid

• Concurrent use of other potent vasopressors (e.g., norepinephrine, phenylephrine) that may cause extreme hypertension.
• Combination with vasodilators such as nitroglycerin or hydralazine, which can blunt therapeutic effect.

Use with caution

• Diuretics that may exacerbate intravascular volume depletion.
• ACE inhibitors or ARBs that influence renal hemodynamics.
• Beta‑blockers, which may mask tachycardia response.