Terlipressin Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

• Different preparations of terlipressin are available (Terlipressin EVER Pharma, Haemopressin, Variquel, Glypressin) -these have different indications and are licensed at different doses for the same indication. The doses have been summarised in this document, regardless of brand used.
• For full information, see manufacturer's SPC

Available preparations

Terlipressin 1mg per 5ml vial (EVER Pharma)

Haemopressin 1mg vial

Glypressin 1mg vial (not routinely stocked in GUH)

Variquel 1mg vial (not routinely stocked in GUH)

Reconstitution

Terlipressin 1mg per 5ml vial (EVER Pharma)

• Already in solution

Haemopressin and Glypressin

• Add 5ml of solvent provided per 1mg vial
• Draw up solvent using a 5 micron filter needle

Variquel

• Already in solution

Infusion fluids

Not required- product ready for use

Methods of intravenous administration

Bolus intravenous injection

• Administer required dose over 1 minute
• Use a large peripheral vein or a central line ^{(ref 4)}

Dose in adults

Short term management of bleeding oesophageal varices

• Give 1 to 2mg, repeated every four to six hours as necessary, until bleeding is controlled, or a period of 72 hours has elapsed ^{(ref 5)}

Type 1 hepato-renal syndrome ^{(ref 6)}

Usual starting dose

• Give 1mg at six hour intervals, for at least three days
• If after three days of treatment the serum creatinine does not decrease by at least 30%, the dose may increase to a maximum of 2mg every six hours

• No response to treatment: (Decrease in serum creatinine is less than 30% of baseline)
  • Interrupt treatment by day 7

• Complete response: (Decrease in serum creatinine below 133micromol/L for at least two consecutive days)
  • Interrupt treatment

• Incomplete response (Serum creatinine drops by at least 30% of baseline but is still greater than 133micromols/L on day 7)
  • Treatment may be continued to a maximum of 14 days

Monitoring

• Monitor blood pressure, heart rate, haematology, fluid balance and electrolytes

Storage

Terlipressin 1mg per 5ml via (EVER Pharma): Store in a fridge

Haemopressin, Glypressin; Store below 25⁰C

Variquel; Store in a fridge

References

(1) Haemopressin SPC Feb 2021

(2) Variquel SPC September 2021

(3) Glypressin SPC July 2020

(4) Injectable Medicines Administration Guide downloaded from Medusa 24/11/2021

(5) Martindale accessed online November 2022

(6) Terlipressin 1mg per 5ml via (EVER Pharma) Jan 28th 2022

Therapeutic classification

Posterior pituitary hormone