Terlirel Injection

About

Terlipressin, known as Terlirel, is a synthetic analogue of vasopressin, primarily acting as a potent vasoconstrictor. Its mechanism involves binding to V1 vasopressin receptors on vascular smooth muscle cells, leading to splanchnic vasoconstriction. This action reduces portal venous pressure and blood flow to the splanchnic circulation, which is crucial in managing conditions like acute esophageal variceal bleeding. Terlipressin also has a longer duration of action compared to natural vasopressin due to its slow conversion to lysine-vasopressin.

Administered intravenously, Terlirel is particularly effective in controlling acute esophageal variceal hemorrhage in patients with cirrhosis. The drug helps to stabilize hemodynamics and improve outcomes by reducing bleeding and preventing re-bleeding episodes, making it a critical intervention in emergency settings. Its targeted vasoconstrictive effect helps to divert blood flow away from the bleeding varices, thereby facilitating hemostasis and improving patient survival.

Uses

• Acute Esophageal Variceal Bleeding
• Hepatorenal Syndrome (Type 1)
• Septic shock (off-label)
• Bleeding from peptic ulcers (off-label)

Directions For Use

Administer intravenously under close medical supervision, typically as a bolus injection followed by continuous infusion, as prescribed.

Benefits

• Controls acute variceal bleeding effectively
• Reduces portal venous pressure
• Improves renal function in Hepatorenal Syndrome
• Stabilizes hemodynamics in critical conditions
• Has a relatively long duration of action
• Reduces need for blood transfusions

Side Effects

• Abdominal pain
• Diarrhea
• Nausea
• Bradycardia
• Hypertension
• Peripheral vasoconstriction
• Arrhythmias
• Chest pain
• Dyspnea
• Headache
• Pallor
• Skin necrosis (rare)

Safety Measures

• Alcohol - Alcohol consumption is generally discouraged in patients with conditions requiring terlipressin (e.g., cirrhosis) due to its detrimental effects on liver health.
• Pregnancy - Contraindicated due to its potent vasoconstrictive effects and potential to induce uterine contractions, which could harm the fetus.
• Breastfeeding - Not recommended due to potential risks to the infant; discontinue breastfeeding if treatment with terlipressin is necessary.
• Liver - Used to treat complications of severe liver disease (e.g., cirrhosis); monitor closely for adverse effects and overall patient response.
• Kidney - Used in hepatorenal syndrome; monitor renal function closely as it can improve or worsen depending on the patient's response.
• Lung - Use with extreme caution in patients with asthma or other respiratory conditions due to potential for bronchoconstriction and respiratory distress.

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