Terlivaz

Generic name: terlipressin

Drug class: Antidiuretic hormones

Dosage form: Powder for solution for injection

Route of administration: Intravenous (IV) injection

Dose: 0.85 mg (1 vial) IV every 6 hours for the first 3 days. If serum creatinine (SCr) decreases by ≥30% from baseline, continue the same dose. If SCr decreases by <30% from baseline, increase the dose to 1.7 mg (2 vials) IV every 6 hours. Treatment continues until 24 hours after two consecutive SCr values ≤1.5 mg/dL at least 2 hours apart or for a maximum of 14 days.

Mechanism of action: Terlipressin is a synthetic vasopressin analogue that acts as a prodrug for lysine-vasopressin. It has a higher selectivity for vasopressin V1 receptors, particularly in the splanchnic circulation, leading to vasoconstriction and increased mean arterial pressure.

Drug usage cases:

• Improvement of kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function.

Drug contraindications:

• Hypoxia or worsening respiratory symptoms.
• Ongoing coronary, peripheral, or mesenteric ischemia.

Side effects:

• Abdominal pain
• Nausea
• Respiratory failure
• Diarrhea
• Dyspnea
• Chest pain or pressure
• Hypoxia symptoms (e.g., restlessness, headache, confusion, rapid heart rate, rapid breathing, anxiety, or breathing problems)
• Blue-colored appearance in skin, lips, fingers, or toes
• Light-headedness, like fainting
• Pain in arms or legs
• Numbness or tingling in hands or feet
• Bloody or tarry stools
• Weight gain or swelling in arms or legs

Warnings:

• Serious or fatal respiratory failure: Assess oxygenation saturation before initiating treatment. Do not initiate in hypoxic patients until oxygenation levels improve. Monitor for hypoxia during treatment and discontinue if SpO₂ decreases below 90%.
• Ineligibility for liver transplant: Adverse reactions may make a patient ineligible for liver transplantation. For patients with high prioritization for liver transplantation (e.g., MELD ≥35), the benefits may not outweigh the risks.
• Ischemic events: May cause cardiac, cerebrovascular, peripheral, or mesenteric ischemia. Avoid use in patients with a history of severe cardiovascular conditions or cerebrovascular or ischemic disease. Discontinue in patients who experience signs or symptoms suggestive of ischemic adverse reactions.
• Embryo-fetal toxicity: May cause fetal harm when administered to a pregnant woman. If used during pregnancy, inform the patient of the potential risk to the fetus.

Use during pregnancy or breastfeeding:

Terlipressin may cause fetal harm when administered to a pregnant woman. If terlipressin is used during pregnancy, the patient should be informed of the potential risk to the fetus.