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terlipressin
FDA approved in USA
Indications:
- hepatorenal syndrome
- does not improve 3 or 6 month survival [1]
- facilitates reversal & may improve survival [3]
- drug of choice [4]
Contraindications:
- hypoxemia
- ischemia:
- coronary ischemia, mesenteric ischemia, peripheral ischemia [4]
Dosage:
- can be given through a peripheral line [4]
- consider concurrent IV albumin [4]
Adverse effects:
- associated with increased incidence of cardiovascular events
Mechanism of action:
- vasopressin analogue
- reverses splanchnic vasodilation associated with hepatic cirrhosis, thus increases effective arterial volume and renal perfusion
General
peptide
gastrointestinal agent
References
- Sanyal AJ et al for the Terlipressin Study Group.
A randomized, prospective, double-blind, placebo-controlled
trial of terlipressin for type 1 hepatorenal syndrome.
Gastroenterology. 2008 May;134(5):1360-8. Epub 2008 Feb 13.
PMID: 18471513
- Martin-Llahi M et al for the TAHRS Investigators.
Terlipressin and albumin vs albumin in patients with cirrhosis
and hepatorenal syndrome: a randomized study.
Gastroenterology. 2008 May;134(5):1352-9. Epub 2008 Feb 14.
PMID: 18471512
- FDA News & Events for human Drugs. Sept 14, 2022
FDA approves treatment to improve kidney function in adults with
hepatorenal syndrome.
https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-improve-kidney-function-adults-hepatorenal-syndrome
- Pitre T, Kiflen M, Helmeczi W
The Comparative Effectiveness of Vasoactive Treatments for Hepatorenal Syndrome:
A Systematic Review and Network Meta-Analysis.
PMID: 35777925
https://journals.lww.com/ccmjournal/Fulltext/2022/10000/The_Comparative_Effectiveness_of_Vasoactive.1.aspx
- Garcia-Tsao G et al.
AGA clinical practice update on the use of vasoactive drugs and intravenous
albumin in cirrhosis: Expert review.
Gastroenterology 2024 Jan; 166:202.
PMID: 37978969
https://www.gastrojournal.org/article/S0016-5085(23)05143-0/fulltext