Glypressin

Bleeding oesophageal varices (BOV). Hepatorenal syndrome (HRS) type 1 in patients who are actively considered for liver transplant.

IV BOV Adult Initially 2 amp every 4 hr. Maintain treatment until bleeding has been controlled for 24 hr up to a max of 48 hr. Patient <50 kg or if adverse effects occur After initial dose, adjust to 1 amp every 4 hr. HRS 1 amp every 6-12 hr by slow IV bolus inj for 7-14 days. May be increased to a max 2 amp every 6 hr if serum creatinine has not decreased by at least 30% from the baseline value after 3 days.

Hypersensitivity. Pregnancy.

Monitor BP, ECG or heart rate, oxygen saturation, serum Na & K levels & fluid balance. Patients w/ cardiovascular or pulmonary disease. Not to be used in patients w/ septic shock w/ low cardiac output; unstable angina or recent acute MI. Inj must be given IV to avoid local necrosis at inj site. Risk of cutaneous ischaemia & necrosis unrelated to inj site in patients w/ DM & obesity. Strictly monitor patients w/ uncontrolled HTN, cerebral or peripheral vascular diseases, cardiac arrhythmias, CAD or previous MI. Possible Torsade de pointes. Patients w/ history of QT interval prolongation, electrolytic abnormalities, concomitant QT interval-prolonging medications. Monitor for smooth muscle constriction in patients w/ severe asthma or COPD. Monitor serum creatinine at least daily in patients w/ renal insufficiency. Carefully monitor fluid balance & electrolytes. Contains Na 30.7 mg/amp. May affect ability to drive & use machines. Lactation. Childn. Elderly. HRS: Rule out other types of acute kidney injury prior to treatment of type 1 hepatorenal syndrome. Avoid in patients w/ advanced renal dysfunction (ie, baseline serum creatinine ≥5.0 mg/dL); severe liver disease (ie, 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 & do not resolve. Possible sepsis/septic shock; monitor patients daily for any signs or symptoms suggestive of infection.

Resp failure, dyspnoea; abdominal pain. Sepsis/septic shock; hyponatraemia; headache; chest pain, bradycardia, tachycardia; vasoconstriction, peripheral ischemia, pallor, HTN, cyanosis; pulmonary oedema, resp distress, dyspnoea; diarrhoea, nausea, vomiting.

Increased hypotensive effect of non-selective β-blockers on the portal vein. May lower heart rate & cardiac output w/ medicines w/ known bradycardic effects (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, diuretics)].

Haemostatics

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

POM