Glypressin

Bleeding oesophageal varices. Emergency treatment of type 1 hepatorenal syndrome as defined by International Ascites Club criteria.

IV Adult Bleeding oesophageal varices Initially 2 mg every 4 hr. It should be maintained until bleeding has been controlled for 24 hr up to a max of 48 hr. <50 kg or if adverse effects occur After initial dose, adjust dose to 1 mg every 4 hr. Type 1 hepatorenal syndrome 3-4 mg given every 24 hr as 3-4 administrations. As an alternative, terlipressin can be administered as continuous IV infusion w/ a starting dose of 2 mg/24 hr & increased to a max of 12 mg/24 hr. Continue until obtaining either of a serum creatinine <130 micromol/L or of a drop of at least 30% in the serum creatinine w/ respect to the value measured at the time of diagnosis of hepatorenal syndrome. Standard ave duration of treatment: 10 days.

Hypersensitivity. Pregnancy.

Monitor BP, ECG or heart rate, oxygen saturation, serum Na & K levels & fluid balance. Particular care in patients w/ CV or pulmonary disease. Exercise caution in patients w/ HTN, recognised heart disease, renal dysfunction, cerebral or peripheral vascular disease, asthma or resp failure. Not to be used in patients w/ septic shock w/ low cardiac output. Administer IV to avoid local necrosis at the inj site. Reports of QT interval prolongation & ventricular arrhythmias including Torsade de pointes. Patients w/ history of QT interval prolongation, electrolyte abnormalities, or concomitant QT interval-prolonging medications. Contains Na 30.7 mg/amp. Lactation. Childn. Elderly. Type 1 hepatorenal syndrome: Ascertain that patient has acute functional renal failure unresponsive to suitable plasma expansion therapy prior to use for hepatorenal syndrome. Avoid in patients w/ advanced renal dysfunction eg, baseline serum creatinine ≥442 micromol/L (5.0 mg/dL); severe liver disease defined as ACLF grade 3 &/or MELD score ≥39. Stabilise new onset of breathing difficulties or worsening of resp disease prior to receiving 1st dose of terlipressin. Co-administration w/ human albumin; consider dose reduction of human albumin in case of signs or symptoms of resp failure or fluid overload; discontinue terlipressin if resp symptoms are severe or do not resolve. Reports of sepsis/septic shock; monitor patients daily for any signs or symptoms suggestive of infection.

Resp failure, dyspnoea. Headache; bradycardia; vasoconstriction, peripheral ischemia, pallor, HTN; pulmonary oedema, resp distress; abdominal pain, diarrhoea; sepsis/septic shock.

Increased hypotensive effects of non-selective β-blockers on the portal vein. May lower heart rate & cardiac output w/ medicines w/ known bradycardic effect (eg, propofol & sufentanil). May trigger Torsade de pointes w/ QT interval-prolonging medications eg, class IA & III antiarrhythmics, erythromycin, certain antihistamines & TCAs, hypokalaemia- or hypomagnesemia-causing medications (eg, some diuretics).

Haemostatics

H01BA04 - terlipressin ; Belongs to the class of vasopressin and analogues. Used in posterior pituitary lobe hormone preparations.

P₁S₁S₃