Vasoactive drugs form the mainstay of
therapy for two of the most important complications of
liver disease:
hepatorenal syndrome (HRS) and acute variceal bleed (AVB). With cumulative evidence supporting the use in
cirrhosis,
terlipressin has been recommended for the management of HRS and AVB. However, owing to the safety concerns,
terlipressin was not approved by food and drug administration (FDA) until now. In this review, we discuss the pharmacology and the major practice-changing studies on the safety and efficacy of
terlipressin in patients with
cirrhosis particularly focusing on existing indications like AVB and HRS and reviewing new data on the expanding indications in
liver disease. The references for this review were identified from PUBMED with MeSH terms such as "
terlipressin," "
hepatorenal syndrome," "
varices, esophagal and gastric," "
ascites" and "
cirrhosis."
Terlipressin, a synthetic analogue of
vasopressin, was introduced in 1975 to overcome the adverse effects of
vasopressin.
Terlipressin is an effective
drug for HRS reversal in patients with
liver cirrhosis and
acute-on-chronic liver failure. There is documented mortality benefit with
terlipressin therapy in HRS and AVB. Adverse effects are common with
terlipressin and need to be monitored strictly. There is some evidence to support the use of this
drug in refractory
ascites, hepatic
hydrothorax, paracentesis-induced circulatory dysfunction and perioperatively during
liver transplantation. However,
terlipressin is not yet recommended for such indications. In conclusion,
terlipressin has stood the test of time with expanding indications and clear prerequisites for clinical use. Our review warrants a fresh perspective on the efficacy and safety of
terlipressin.