Monday January 11, 2010
A note on Terlipressin


Terlipressin is an analogue of vasopressin with longer half life. Over the past few years there has been much interest in the use of terlipressin both in adults and children. Vasopressin mediates vasoconstriction via V1 receptors and increases intracellular calcium concentration. Terlipressin (triglycyl lysine vasopressin) is a long-acting vasopressin analog. In part, it is a prodrug that is slowly cleaved in vivo to lysine vasopressin by endo- and exopeptidases in the liver and kidney over 4-6 hrs, thereby allowing prolonged effects by intermittent intravenous injections rather than continuous intravenous infusion.

Terlipressin is administered as a single bolus of 1 mg (the dosage used in gastroenterological indications) in patients with septic shock refractory to catecholamine/hydrocortisone/methylene blue. A significant improvement in blood pressure can be seen during the first 5 hours. Partial or total weaning from catecholamines is possible.

Terlipressin (1 or 2 mg intravenously) is able to reverse the intractable hypotension, with a concomitant decrease in heart rate and CI. With Terlipressin renal function and gastric mucosal perfusion are improved.

One serious concern is raised by the high incidence of ischaemia during terlipressin administration (skin and/or limb ischaemia).

In conclusion, use of terlipressin may be considered in patients with (truly) refractory septic shock despite adequate fluid resuscitation and high-dose conventional vasopressors.