Adult: In acute cases: As terlipressin acetate: Initially, 1-2 mg (0.85-1.7 mg terlipressin) 4 hourly; maintain treatment until bleeding is controlled for 24 hours up to Max of 48 hours. May be reduced to 1 mg 4 hourly, if needed, particularly in patients weighing <50 kg or if adverse reactions occur. Doses are given via IV inj. Dose expressions and recommendations may vary among countries and between individual products (refer to specific product or local guidelines).
Intravenous Hepatorenal syndrome type 1
Adult: In patients with rapid reduction in kidney function: As terlipressin acetate: Initially, 1 mg 4-6 hourly. If serum creatinine (SCr) has not decreased by at least 25% after 3 days of treatment: Increase to 2 mg 4-6 hourly or up to Max of 12 mg daily. If SCr does not decrease to <1.5 mg/dL: Discontinue treatment. As terlipressin: Initially, 0.85 mg 6 hourly for 3 days. Adjust dose based on SCr starting on Day 4: If SCr has decreased by ≥30% from baseline: Continue 0.85 mg 6 hourly until 24 hours after achieving 2 consecutive creatinine values (at least 2 hours apart) of ≤1.5 mg/dL or for a Max of 14 days. If SCr has decreased by <30% from baseline: Increase to 1.7 mg 6 hourly, then continue until 24 hours after achieving 2 consecutive creatinine values (at least 2 hours apart) of ≤1.5 mg/dL or for a Max of 14 days. If SCr at or above baseline: Discontinue treatment. Doses are given via IV bolus inj over 2 minutes. Dose expressions and recommendations may vary among countries and between individual products (refer to specific product or local guidelines).
What are the brands available for Terlipressin in Singapore?
Powder for solution for inj: Reconstitute with 5 mL of NaCl 0.9% solution.
Contraindications
Hypoxia or worsening respiratory symptoms; ongoing coronary, peripheral or mesenteric ischaemia. Pregnancy.
Special Precautions
Patient with CV or pulmonary disease, hypertension, diabetes mellitus, history of QT interval prolongation, electrolyte abnormalities (e.g. hypokalaemia, hypomagnesaemia), fluid overload; history of severe CV conditions, cerebrovascular and ischaemic disease. Obese patients. Avoid use in patients with septic shock and low cardiac output. When used for hepatorenal syndrome: Advanced renal dysfunction (baseline SCr >5 mg/dL) and severe liver disease (defined as Acute-on-Chronic Liver Failure grade 3 and/or a Model for End-stage Liver Disease score ≥39). Lactation.
Monitor blood pressure, heart rate, oxygen saturation, ECG, serum sodium and potassium levels, fluid balance during treatment; SCr (at baseline). Assess for signs and symptoms of hyponatraemia, fluid balance, or ischaemia during treatment.
Drug Interactions
Increased risk of QT interval prolongation with QT-prolonging drugs (e.g. class Ia or III antiarrhythmics, erythromycin, certain antihistamines, TCAs, drugs that cause hypokalaemia or hypomagnesaemia). Increased hypotensive effect on the portal vein with non-selective β-blockers. Increased risk of low heart rate and cardiac output with drugs which have a bradycardic effect (e.g. propofol, sufentanil).
Action
Description: Overview: Terlipressin is a synthetic vasopressin analogue with twice the selectivity for vasopressin V1 receptors compared with V2 receptors. It acts as a prodrug for lysine-vasopressin and has a pharmacologic activity on its own. Mechanism of Action: Terlipressin is converted via slow enzymatic cleavage into lysine-vasopressin, which results in an extended duration of systemic vasoconstriction. It is believed to decrease portal hypertension and portal blood circulation, thereby increasing effective arterial volume and mean arterial pressure (MAP), which enhances renal blood flow. Pharmacodynamics: In hepatorenal syndrome type 1 (HRS-1), increases of diastolic, systolic and MAPs were observed. Onset: Increased blood pressure and MAP, and decreased heart rate: Within 5 minutes. Duration: ≥6 hours. Pharmacokinetics: Absorption: Time to peak plasma concentration: 1.2-2 hours post dose (maximal change in blood pressure and heart rate). Distribution: Volume of distribution: 6.3 L (terlipressin); 1,370 L (lysine-vasopressin). Metabolism: Metabolised via enzymatic cleavage by various tissue peptidases into lysine-vasopressin (active metabolite). Excretion: Via urine (<1 % [terlipressin]; <0.1% [lysine-vasopressin]). Terminal elimination half-life: 0.9 hours (terlipressin); 3 hours (lysine-vasopressin).
Chemical Structure
Terlipressin Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 72081, Terlipressin. https://pubchem.ncbi.nlm.nih.gov/compound/Terlipressin. Accessed Nov. 25, 2025.
Storage
Powder for solution for inj/Solution for inj: Store between 2-8°C. Protect from light. Reconstituted solution: May be stored below 25°C for up to 48 hours.
H01BA04 - terlipressin ; Belongs to the class of vasopressin and analogues. Used in posterior pituitary lobe hormone preparations.
References
Brayfield A, Cadart C (eds). Terlipressin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/11/2025.Erylize 1 mg/8.5 mL Solution for Injection (Pharmaniaga Marketing Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 12/11/2025.Glypressin 1 mg Powder and Solevnt for Solution for Injection (Ferring Pharmaceuticals Ltd). MHRA. https://products.mhra.gov.uk. Accessed 06/11/2025.Glypressin 1 mg/8.5 mL Solution for Injection (Ferring Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 12/11/2025.Joint Formulary Committee. Terlipressin Acetate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/11/2025.Pharmaco (NZ) Ltd. Glypressin 1 mg/8.5 mL Solution for Injection data sheet 21 July 2011. Medsafe. http://www.medsafe.govt.nz. Accessed 06/11/2025.Terlipressin Acetate 1 mg Solution for Injection (Flynn Pharma Ltd). MHRA. https://products.mhra.gov.uk. Accessed 06/11/2025.Terlipressin Acetate. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/11/2025.Terlipressin Injection, Powder, Lyophilized, for Solution (Mallinckrodt Hospital Products Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/11/2025.Terlipressin. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/11/2025.Terlivaz Injection, Powder, Lyophilized, for Solution (Mallinckrodt Hospital Products Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/11/2025.
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