Terlipressin SUN: Uses, Dosage & Side Effects
A synthetic vasopressin analogue used for emergency treatment of acute bleeding from esophageal varices in patients with portal hypertension
Terlipressin SUN is a synthetic analogue of vasopressin (a posterior pituitary hormone) used for the emergency management of acute bleeding from esophageal varices—dilated veins in the esophagus that can rupture and cause life-threatening hemorrhage, most commonly in patients with liver cirrhosis and portal hypertension. Terlipressin works by constricting the splanchnic blood vessels, thereby reducing portal venous pressure and controlling variceal bleeding. It is administered by slow intravenous injection in a hospital setting under continuous cardiac and circulatory monitoring. Terlipressin SUN is listed on the WHO Model List of Essential Medicines and is recommended by international guidelines (EASL, Baveno VII) as first-line vasoactive therapy for acute variceal hemorrhage.
Quick Facts: Terlipressin SUN
Key Takeaways
- Terlipressin SUN is a synthetic vasopressin analogue used as emergency treatment for acute bleeding from esophageal varices, most commonly caused by liver cirrhosis and portal hypertension.
- It works by constricting splanchnic blood vessels to reduce portal pressure by 15–20%, thereby decreasing blood flow to the varices and helping control the hemorrhage.
- Treatment is administered by slow intravenous injection in a hospital setting under continuous cardiac monitoring, typically for 2–3 days until definitive endoscopic therapy can be performed.
- Serious cardiovascular side effects are possible, including myocardial ischemia, arrhythmias, and tissue necrosis—the drug must not be used in patients with a known allergy to terlipressin.
- The drug is included on the WHO Model List of Essential Medicines and is recommended as first-line vasoactive therapy by EASL and Baveno VII consensus guidelines alongside endoscopic treatment.
What Is Terlipressin SUN and What Is It Used For?
Terlipressin SUN contains the active substance terlipressin in the form of terlipressin acetate. Terlipressin is a synthetic prodrug analogue of the naturally occurring hormone vasopressin (also known as antidiuretic hormone, or ADH). In the body, terlipressin is slowly cleaved by tissue endopeptidases to release the biologically active metabolite lysine-vasopressin. This slow, sustained release gives terlipressin a significantly longer duration of pharmacological action compared with vasopressin itself, allowing intermittent intravenous bolus dosing rather than continuous infusion.
The primary therapeutic use of Terlipressin SUN is in the management of acute variceal hemorrhage—specifically bleeding from esophageal varices. Esophageal varices are abnormally enlarged (dilated) veins in the lower part of the esophagus (the tube connecting the throat to the stomach). They develop as a consequence of portal hypertension, a condition in which blood pressure in the portal venous system (the network of veins draining the abdominal organs to the liver) becomes dangerously elevated. Portal hypertension most commonly results from liver cirrhosis, a condition in which chronic liver damage leads to scarring and impaired blood flow through the liver.
When portal pressure rises, blood seeks alternative routes back to the systemic circulation, flowing through collateral vessels including the submucosal veins of the esophagus and stomach. Over time, these thin-walled vessels become progressively dilated under the abnormally high pressure. Variceal rupture and subsequent hemorrhage is one of the most serious and life-threatening complications of portal hypertension, carrying a mortality rate of approximately 15–20% per bleeding episode despite modern medical care. Acute variceal bleeding is a medical emergency requiring immediate treatment.
Terlipressin acts primarily on vasopressin V1 receptors located in vascular smooth muscle. By activating these receptors in the splanchnic circulation (the blood vessels supplying the intestines, stomach, and other abdominal organs), terlipressin causes powerful vasoconstriction. This splanchnic vasoconstriction reduces the volume of blood flowing into the portal venous system, thereby lowering portal pressure by approximately 15–20% within 15–30 minutes of administration. The reduction in portal pressure translates directly into decreased blood flow through the esophageal varices, which helps to control or arrest the acute hemorrhage.
International clinical practice guidelines, including those published by the European Association for the Study of the Liver (EASL) and the Baveno VII Consensus Workshop, recommend vasoactive therapy with terlipressin (or alternatively octreotide or somatostatin) as a first-line intervention in acute variceal bleeding. Vasoactive drugs should be started as early as possible—ideally before endoscopy—and continued for up to 2–5 days following the bleeding episode. Terlipressin is typically used as adjunctive therapy to endoscopic treatment (such as band ligation or sclerotherapy), which provides definitive hemostasis. The combination of vasoactive drugs and endoscopic therapy has been shown to improve bleeding control and reduce mortality compared with either intervention alone.
Terlipressin is included on the World Health Organization (WHO) Model List of Essential Medicines, underscoring its importance in the management of acute variceal bleeding globally. It is considered one of the most effective pharmacological agents available for this life-threatening condition and is widely used in emergency departments and intensive care units throughout Europe, Asia, and other regions where it is approved.
What Should You Know Before Receiving Terlipressin SUN?
Because Terlipressin SUN is administered in an emergency hospital setting, you may not have the opportunity to provide a detailed medical history before treatment begins. However, if you are able to communicate, it is critically important to inform the treating physicians about any of the conditions listed below, as they may influence the decision to use terlipressin or require more intensive monitoring during treatment.
Contraindications
Terlipressin SUN must not be administered to patients with a known hypersensitivity (allergy) to terlipressin or to any of the other ingredients in the formulation. The excipients include sodium acetate trihydrate, sodium chloride, acetic acid (for pH adjustment), and water for injections. An allergic reaction to terlipressin could manifest as difficulty breathing, swelling of the face or throat, skin rash, or a sudden drop in blood pressure—any of which requires immediate medical intervention.
Warnings and Precautions
Terlipressin causes vasoconstriction that is not limited to the splanchnic circulation. It can also affect the coronary, cerebral, and peripheral blood vessels, potentially causing myocardial ischemia (reduced blood flow to the heart), cardiac arrhythmias, stroke, and peripheral tissue ischemia including skin necrosis. Continuous cardiac and hemodynamic monitoring is mandatory throughout the treatment period.
The following conditions require special caution and enhanced monitoring if terlipressin is to be used:
- Septic shock: Patients with severe sepsis or septic shock may have compromised cardiovascular function, and the vasoconstrictive effects of terlipressin could exacerbate hemodynamic instability or tissue hypoperfusion.
- Bronchial asthma or respiratory conditions: Terlipressin may cause bronchoconstriction, which can be particularly dangerous in patients with pre-existing asthma or chronic obstructive pulmonary disease (COPD).
- Acute coronary syndrome: Patients with recent or ongoing myocardial ischemia, angina pectoris, or a history of myocardial infarction are at increased risk of coronary vasoconstriction and further cardiac events when exposed to terlipressin.
- Uncontrolled hypertension: Terlipressin can cause significant increases in blood pressure, which in the setting of pre-existing uncontrolled hypertension, may lead to hypertensive crisis, stroke, or cardiac complications.
- Cardiac arrhythmias: Terlipressin can trigger or worsen irregular heart rhythms, including bradycardia and potentially life-threatening arrhythmias such as torsades de pointes, particularly in patients with pre-existing conduction abnormalities or electrolyte imbalances.
- Cerebrovascular disease: Patients with a history of stroke or transient ischemic attack (TIA) may experience reduced cerebral blood flow due to the vasoconstrictive effects of terlipressin.
- Peripheral vascular disease: Terlipressin can significantly reduce blood flow to the extremities, potentially causing or worsening ischemia in patients with pre-existing peripheral arterial disease.
- Renal insufficiency: Patients with chronic kidney disease may have impaired clearance of terlipressin and may be more susceptible to the drug’s hemodynamic effects. Renal function should be monitored closely.
- Electrolyte imbalances: Abnormal levels of sodium, potassium, or other electrolytes in the blood increase the risk of cardiac arrhythmias during terlipressin therapy. Electrolytes should be corrected before and monitored during treatment.
- Hypovolemia or dehydration: Patients who are dehydrated or have lost a significant volume of blood may have exaggerated hemodynamic responses to terlipressin. Volume resuscitation should be performed concurrently.
- Patients over 70 years: Elderly patients are at higher risk of cardiovascular complications from terlipressin and require particularly careful monitoring. The risk-benefit assessment should be documented.
Children and Adolescents
Terlipressin SUN is not recommended for use in children and adolescents (under 18 years of age) due to insufficient clinical experience regarding safety and efficacy in this population. The pharmacokinetics and pharmacodynamics of terlipressin have not been adequately studied in pediatric patients. In the rare clinical scenarios where variceal bleeding occurs in pediatric patients (such as in pediatric liver disease), alternative management strategies should be discussed with a specialist.
Pregnancy and Breastfeeding
Terlipressin SUN should only be used during pregnancy if the treatment is considered absolutely life-saving for the mother. Terlipressin has been shown to cause uterine contractions and decreased uterine blood flow, both of which pose significant risks to the developing fetus, including the possibility of premature labor, fetal distress, or fetal death. The decision to use terlipressin in a pregnant patient must be made on a case-by-case basis, weighing the severity of the variceal hemorrhage and the immediate threat to the mother’s life against the potential harm to the unborn child.
It is not known whether terlipressin or its active metabolite lysine-vasopressin is excreted in human breast milk. Because the potential effects on the breastfed infant are unknown, breastfeeding mothers should discuss the potential risks with their healthcare provider. Given that terlipressin is used only in acute emergency settings with short treatment durations (2–3 days), the practical implications for breastfeeding are typically limited, but a temporary interruption of breastfeeding may be advised.
Driving and Operating Machinery
No formal studies have been conducted on the effect of terlipressin on the ability to drive or operate machinery. However, given the severity of the clinical condition for which terlipressin is prescribed (acute variceal hemorrhage requiring hospital admission), the question of driving ability is not relevant during the acute treatment phase. After discharge from hospital, patients should not drive or operate machinery until they feel well enough to do so and should follow their doctor’s advice.
Important Information About Sodium Content
Terlipressin SUN contains 361 mg (15.7 mmol) of sodium per dose. This is equivalent to approximately 18% of the WHO-recommended maximum daily dietary intake of sodium for an adult. This sodium content should be taken into consideration for patients on a sodium-restricted diet, although in the emergency setting of acute variceal bleeding, the immediate clinical priority of controlling the hemorrhage will generally outweigh dietary sodium considerations.
How Does Terlipressin SUN Interact with Other Drugs?
Drug interactions with terlipressin primarily involve its cardiovascular effects, particularly its tendency to slow the heart rate (bradycardia) and cause vasoconstriction. Medications that independently affect heart rate, cardiac conduction, blood pressure, or electrolyte balance may have additive or synergistic effects when combined with terlipressin, increasing the risk of serious cardiac events. In the emergency setting, it is essential for the treating team to review all concurrent medications as quickly as possible.
Major Interactions
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Beta-blockers (e.g., propranolol, metoprolol) | Additive bradycardia and risk of severe hypotension | Enhanced cardiac monitoring required; many cirrhotic patients take non-selective beta-blockers for variceal prophylaxis |
| Propofol | Additive bradycardia and potential hemodynamic instability | Monitor closely during sedation for endoscopy; consider alternative sedatives |
| Class IA antiarrhythmics (quinidine, procainamide, disopyramide) | Risk of QT prolongation and torsades de pointes | Avoid combination if possible; continuous ECG monitoring mandatory |
| Class III antiarrhythmics (amiodarone, sotalol, ibutilide, dofetilide) | Risk of QT prolongation and life-threatening arrhythmias | Avoid combination if possible; continuous ECG monitoring mandatory |
Minor Interactions
| Interacting Drug | Effect | Clinical Significance |
|---|---|---|
| Erythromycin | QT prolongation risk when combined with terlipressin | Monitor ECG; consider alternative antibiotics in cirrhotic patients |
| Antihistamines (certain types) | Some antihistamines prolong the QT interval | Use non-QT-prolonging antihistamines if needed |
| Tricyclic antidepressants | QT prolongation and additive cardiac conduction effects | Enhanced cardiac monitoring during concomitant use |
| Diuretics (loop, thiazide) | Electrolyte depletion (hypokalemia, hypomagnesemia) increases arrhythmia risk | Correct electrolytes before and during terlipressin therapy; monitor levels closely |
It is important to note that many patients presenting with acute variceal bleeding have advanced liver cirrhosis and may be on multiple medications, including non-selective beta-blockers (for portal hypertension prophylaxis), diuretics (for ascites management), and antibiotics. The treating team must carefully consider the potential for drug interactions and adjust monitoring and therapy accordingly. In practice, the life-threatening nature of acute variceal hemorrhage typically justifies the use of terlipressin despite potential interactions, but enhanced monitoring is essential.
What Is the Correct Dosage of Terlipressin SUN?
Terlipressin SUN is always administered by a physician or qualified healthcare professional in a hospital setting. It is given as a slow intravenous injection. The patient must be under continuous cardiac and hemodynamic monitoring throughout the treatment period. The dose is individualized based on the patient’s body weight and clinical response.
Adults
Initial Dose (Weight-Based)
Body weight under 50 kg: 1 mg terlipressin acetate (8.5 mL solution)
Body weight 50–70 kg: 1.5 mg terlipressin acetate (12.75 mL solution)
Body weight over 70 kg: 2 mg terlipressin acetate (17 mL solution)
The initial dose is administered via slow intravenous injection over at least 1 minute.
Maintenance Dose
Dose: 1 mg terlipressin acetate (8.5 mL solution) every 4 to 6 hours
Maximum daily dose: Approximately 120 micrograms terlipressin acetate per kg body weight
Duration: Treatment should be limited to 2–3 days, adjusted according to the clinical course of the bleeding
The maintenance dose may be continued until definitive endoscopic hemostasis is achieved and maintained, or until the clinical situation allows discontinuation.
Elderly Patients
Patients over 70 years of age are at higher risk of cardiovascular complications from terlipressin, including myocardial ischemia, arrhythmias, and peripheral ischemia. Terlipressin should only be used in elderly patients with particular caution, and the benefits of treatment must clearly outweigh the risks. Enhanced cardiovascular monitoring is recommended, and the lowest effective dose should be considered. The treating physician should document the risk-benefit assessment.
Children and Adolescents
Terlipressin SUN is not recommended for use in children and adolescents under 18 years of age due to insufficient data on safety and efficacy in this population. There are no established pediatric dosing guidelines for terlipressin. In the rare event that a pediatric patient presents with variceal bleeding, alternative pharmacological and endoscopic management strategies should be discussed with a pediatric hepatologist or gastroenterologist.
Renal and Hepatic Impairment
Patients with chronic kidney disease (renal insufficiency) require cautious use of terlipressin, as they may be more susceptible to the drug’s hemodynamic effects and may have impaired clearance. Renal function should be monitored during treatment. No dose adjustment is required for patients with hepatic impairment, which is relevant given that the vast majority of patients receiving terlipressin for variceal bleeding have significant underlying liver disease including cirrhosis.
Overdose
An overdose of Terlipressin SUN may result in a rapid and dangerous increase in blood pressure, particularly in patients with pre-existing hypertension. Symptoms of overdose may include severe headache, visual disturbances, chest pain, and cardiac arrhythmias. If an overdose occurs, the blood pressure rise can be managed with an alpha-adrenergic blocker such as clonidine. Bradycardia (abnormally slow heart rate) associated with terlipressin overdose can be treated with atropine. Intensive monitoring and supportive care should be maintained throughout.
Missed Dose
As Terlipressin SUN is administered by healthcare professionals in a hospital setting, the timing and scheduling of doses are managed directly by the treating medical team. If a dose is inadvertently delayed, it should be given as soon as possible, and subsequent doses should continue at the prescribed interval. Patients do not need to take any action regarding missed doses, as the treating physicians and nurses manage the dosing schedule.
What Are the Side Effects of Terlipressin SUN?
Like all medicines, Terlipressin SUN can cause side effects, although not everybody gets them. The side effects of terlipressin are primarily related to its vasoconstrictive mechanism of action, which can affect blood vessels throughout the body—not just those in the splanchnic circulation. Continuous cardiac monitoring during treatment allows for the early detection and management of cardiovascular side effects.
Tell your doctor immediately if you experience any of the following serious side effects during or after terlipressin treatment: severe shortness of breath or difficulty breathing (asthma attack or respiratory failure), severe chest pain (angina), persistent and significant irregular heartbeat, areas of dead or discolored skin (necrosis), seizures (convulsions), or signs of kidney failure (decreased urine output, swelling). Treatment should be discontinued if these occur.
Common
- Headache
- Bradycardia (slow heart rate)
- Signs of reduced coronary blood flow on ECG
- Hypertension (high blood pressure)
- Hypotension (low blood pressure)
- Reduced peripheral blood circulation, pale skin
- Abdominal cramps
- Diarrhea
Uncommon
- Hyponatremia (low sodium levels in blood) if uncontrolled
- Skin necrosis (death of skin tissue) at sites other than the injection site
- Rapid increase in blood pressure
- Tachycardia (palpitations, fast heart rate)
- Tissue swelling or pulmonary edema (fluid in the lungs)
- Chest pain
- Myocardial infarction (heart attack)
- Heart failure (torsades de pointes)
- Insufficient blood flow to the intestines (intestinal ischemia)
- Uterine cramps and decreased uterine blood flow
- Cyanosis (bluish discoloration of skin or lips)
- Hot flushes
- Nausea (transient)
- Vomiting (transient)
- Lymphangitis (inflammation of lymphatic vessels)
Rare
- Dyspnea (shortness of breath)
Very Rare
- Hyperglycemia (high blood sugar)
- Stroke (cerebrovascular accident)
The cardiovascular side effects of terlipressin are a direct consequence of its vasoconstrictive properties. By constricting blood vessels, terlipressin can reduce blood flow not only in the desired splanchnic territory but also in the coronary arteries (potentially causing angina or myocardial infarction), cerebral arteries (potentially causing stroke), peripheral arteries (causing pale, cold extremities or skin necrosis), and intestinal vessels (causing intestinal ischemia). These effects are generally dose-related and more likely to occur in patients with pre-existing cardiovascular disease.
Skin necrosis is a particularly notable adverse effect that may occur at sites distant from the injection site. It is caused by severe vasoconstriction of the cutaneous blood vessels and has been reported in various locations on the body. If any area of skin becomes pale, discolored, painful, or develops blistering, the treating team should be informed immediately and treatment may need to be discontinued.
Hyponatremia (abnormally low sodium levels in the blood) can occur as a result of the antidiuretic effect of lysine-vasopressin, the active metabolite of terlipressin. This effect promotes water retention by the kidneys, which can dilute the sodium concentration in the blood. Electrolyte levels, particularly sodium, should be monitored regularly during terlipressin therapy, and fluid balance should be carefully managed.
It is important to report any suspected side effects after a medicine has been authorized. This allows continuous monitoring of the benefit-risk balance of the medicine. Healthcare professionals and patients are encouraged to report suspected adverse reactions to their national pharmacovigilance authority.
How Should You Store Terlipressin SUN?
Terlipressin SUN requires specific storage conditions to maintain its stability and efficacy. The solution for injection must be stored in a refrigerator at a temperature between 2°C and 8°C (36°F–46°F). It should not be frozen, and the ampoules should be kept in the outer carton to protect from light. In a hospital setting, the pharmacy and nursing staff are responsible for ensuring that the product is stored correctly before administration.
The medicine must not be used after the expiry date stated on the carton and ampoule label (abbreviated as “EXP” or “Exp. date”). The expiry date refers to the last day of the indicated month. Before administration, the solution should be visually inspected for particles and discoloration. Terlipressin SUN should be a clear, colorless solution without visible particles. If the solution appears cloudy, discolored, or contains particles, it must not be used.
As with all medicines, Terlipressin SUN should be kept out of the sight and reach of children. Unused medicine or waste material should be disposed of in accordance with local requirements for the disposal of pharmaceutical waste. Do not throw medicines down the drain or in household waste. These measures are designed to help protect the environment.
What Does Terlipressin SUN Contain?
Terlipressin SUN is supplied as a ready-to-use solution for injection. Understanding the composition of the product is important for identifying potential allergies to any of the ingredients and for being aware of the sodium content, which is relevant for patients on sodium-restricted diets.
Active Ingredient
The active substance is terlipressin in the form of terlipressin acetate. Each ampoule contains 1 mg terlipressin acetate in 8.5 mL of solution for injection, which corresponds to 0.85 mg of terlipressin. This provides a concentration of 0.12 mg terlipressin acetate per mL (equivalent to 0.1 mg terlipressin per mL). Terlipressin is a synthetic triglycyl derivative of lysine-vasopressin that acts as a prodrug, being slowly converted to the pharmacologically active lysine-vasopressin by endopeptidases in the body.
Inactive Ingredients (Excipients)
- Sodium acetate trihydrate: Used as a buffering agent to maintain the pH of the solution
- Sodium chloride: Used to adjust the osmolality (salt concentration) of the solution to make it compatible with intravenous administration
- Acetic acid: Used for pH adjustment to ensure stability
- Water for injections: The solvent vehicle
Appearance and Packaging
Terlipressin SUN is a clear, colorless solution for injection without visible particles. It is supplied in glass ampoules, with each ampoule containing 8.5 mL of solution. The product is packaged in cartons of 5 ampoules. The manufacturing authorization holder is Sun Pharmaceutical Industries Europe B.V., based in Hoofddorp, Netherlands. Terlipressin SUN is approved and marketed throughout the European Economic Area under various trade names in different member states.
Frequently Asked Questions About Terlipressin SUN
Terlipressin is a synthetic prodrug analogue of vasopressin (also known as antidiuretic hormone). The key differences are: (1) terlipressin has a longer duration of action (4–6 hours vs. minutes for vasopressin), allowing intermittent bolus dosing instead of continuous infusion; (2) terlipressin has greater selectivity for V1 receptors in vascular smooth muscle, resulting in more targeted splanchnic vasoconstriction with fewer systemic cardiovascular side effects; and (3) terlipressin has a better safety profile overall, with lower rates of myocardial ischemia and other serious cardiovascular events compared to vasopressin infusion. These advantages have made terlipressin the preferred vasopressin-type agent for variceal bleeding in most international guidelines.
Terlipressin begins to lower portal pressure within minutes of intravenous administration. Studies show a reduction in portal pressure of approximately 15–20% within 15–30 minutes of the first injection. Clinical improvement in bleeding may be observed even before endoscopy is performed. The pharmacological effect of each dose lasts approximately 4–6 hours, which is why repeat dosing every 4–6 hours is recommended during the acute treatment period.
No, terlipressin must always be administered in a hospital setting by qualified healthcare professionals. This is because: (1) acute variceal bleeding is a medical emergency requiring comprehensive intensive care; (2) terlipressin requires continuous cardiac and circulatory monitoring during treatment due to the risk of serious cardiovascular side effects; (3) the drug is given by intravenous injection, which requires clinical expertise; and (4) endoscopic treatment is typically performed alongside terlipressin therapy to achieve definitive hemostasis. Patients should never attempt to use this medication outside of a supervised hospital environment.
No, terlipressin and octreotide are different drugs with different mechanisms of action, although both are used to treat acute variceal bleeding. Terlipressin is a vasopressin analogue that works by directly constricting splanchnic blood vessels (V1 receptor agonism). Octreotide is a somatostatin analogue that works by inhibiting the release of vasodilatory hormones such as glucagon, thereby indirectly reducing splanchnic blood flow and portal pressure. Both are recommended as first-line vasoactive agents by international guidelines (EASL, Baveno VII), and the choice between them often depends on local availability and clinical practice. A key practical difference is that terlipressin can be given as intermittent bolus injections, while octreotide typically requires continuous intravenous infusion.
Clinical trials and systematic reviews have shown that terlipressin controls variceal bleeding in approximately 75–80% of cases when used as the sole vasoactive agent. When combined with endoscopic band ligation (the current standard of care), success rates for initial hemostasis exceed 90%. A Cochrane systematic review of terlipressin for acute variceal hemorrhage found that terlipressin significantly reduces all-cause mortality and improves control of bleeding compared with placebo. Terlipressin is the only vasoactive drug that has been shown in randomized controlled trials to reduce mortality in acute variceal bleeding.
All information on this page is based on international medical guidelines, regulatory documents, and peer-reviewed research, including: the EMA-approved Summary of Product Characteristics (SmPC) for Terlipressin SUN; EASL Clinical Practice Guidelines on the management of variceal haemorrhage (2022); Baveno VII Consensus Workshop on Portal Hypertension (2022); Cochrane Database Systematic Review on terlipressin for acute esophageal variceal hemorrhage; WHO Model List of Essential Medicines (2023); and AASLD Practice Guidance on Portal Hypertension and Variceal Hemorrhage (2024). All medical claims have evidence level 1A, the highest quality of evidence based on systematic reviews of randomized controlled trials.
References
- European Medicines Agency (EMA). Terlipressin SUN – Summary of Product Characteristics. Last revised 2025.
- European Association for the Study of the Liver (EASL). Clinical Practice Guidelines on the management of variceal haemorrhage. Journal of Hepatology. 2022;77(4):768–786.
- de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII – Renewing consensus in portal hypertension. Journal of Hepatology. 2022;76(4):959–974.
- Ioannou GN, Doust J, Rockey DC. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database of Systematic Reviews. 2003;(1):CD002147. Updated 2023.
- World Health Organization (WHO). Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023.
- Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management – 2016 practice guidance by the American Association for the Study of Liver Diseases (AASLD). Updated 2024. Hepatology. 2017;65(1):310–335.
- British National Formulary (BNF). Terlipressin acetate. National Institute for Health and Care Excellence (NICE). 2025.
- Levacher S, Letoumelin P, Pateron D, et al. Early administration of terlipressin plus glyceryl trinitrate to control active upper gastrointestinal bleeding in cirrhotic patients. The Lancet. 1995;346(8979):865–868.
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