Terlipressin

CLASS

  • synthetic vasopressin analogue

MECHANISM OF ACTION

  • synthetic vasopressin analogue with relative specificity for the splanchnic circulation where it causes vasoconstriction in these vessels with a reduction in portal pressure.

PHARMACEUTICS

  • powder that must be mixed

DOSE

  • 1-2mg Q6 hourly

INDICATIONS

  • acute variceal bleeding
  • hepatorenal syndrome (HRS)

ADVERSE EFFECTS

  • low cardiac output state c/o vasoconstriction
  • AF
  • MI
  • heart failure
  • GI upset
  • hyponatraemia

PHARMACOKINETICS

  • Absorption
  • Distribution
  • Metabolism
  • Elimination

EVIDENCE

Variceal haemorrhage

  • Seo et al, 2014
    • In terms of mortality and re-bleeding rates, there seem to be no difference between terlipressin, somatotatin and octreotide

Hepatorenal syndrome

  • Israelsen et al, 2015 meta-analysis
    • terlipressin is more effective than placebo, and  equal with noradrenaline in efficacy
    • Terlipressin reduces mortality from Type 1 HRS

Septic shock

  • Terlipressin is not typically used for septic shock in clinical practice
  • TERLIVAP study (Morelli et al, 2009)
    • small single-center non-blinded RCT
    • terlipressin infusion was comparable to vasopressin for treatment of septic shock

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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