Glypressin

Bleeding esophageal varices. Type 1 hepatorenal syndrome characterized by spontaneous acute renal insufficiency in patients suffering from severe cirrhosis w/ ascites.

IV Bleeding esophageal varices Adult Initially 2 mg every 4 hr. Maintain treatment until bleeding is controlled for 24 hr, up to max 48 hr. After initial dose, can be adjusted to 1 mg every 4 hr in patient w/ body wt <50 kg or if adverse effects occur. Type 1 hepatorenal syndrome 3-4 mg every 24 hr as 3 or 4 administrations. Standard ave duration of treatment: 10 days.

Hypersensitivity. Pregnancy.

Must be given IV to avoid necrosis at inj site. Regularly monitor BP, ECG or heart rate, O₂ saturation, Na & K serum levels & fluid balance during treatment. May induce ischaemia & pulmonary vascular congestion; caution in patients w/ CV or pulmonary disease. Not to be used in patients w/ septic shock w/ low cardiac output. Post-marketing reports of cutaneous ischaemia & necrosis unrelated to inj site, especially in patients w/ DM & obesity. Reports of QT interval prolongation & ventricular arrhythmias including torsade de pointes; caution in patients w/ history of QT interval prolongation, electrolyte abnormalities, or concomitant medications that prolong QT interval. Decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy should be made taking into account the benefit of breast-feeding to the child & benefit of therapy to woman. Caution in childn & elderly. Type 1 hepatorenal syndrome: Rule out other types of acute kidney injury prior to treatment. Avoid in patients w/ advanced renal dysfunction ie, baseline serum creatinine ≥442 micromol/L (5 mg/dL) or severe liver disease defined as Acute-on-Chronic Liver Failure (ACLF) grade 3 &/or Model for End-Stage Liver Disease (MELD) score ≥39. Reports of fatal cases of resp failure including resp failure due to fluid overload. Patients w/ new onset of breathing difficulties or worsening of resp disease should be stabilised prior to receiving 1st dose of treatment. Discontinue treatment if resp symptoms are severe or do not resolve. Caution when co-administered w/ human albumin. Report of sepsis/septic shock, including fatal cases. 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.

Increased hypotensive effect of non-selective β-blockers on portal vein. May lower heart rate & cardiac output w/ medicinal products w/ known bradycardic effect (eg, propofol, sufentanil). Risk of torsade de pointes w/ medications that can prolong QT interval eg, class IA & III antiarrhythmics, erythromycin, certain antihistamines & TCAs or medications that may cause hypokalemia or hypomagnesemia (eg, some diuretics).

Haemostatics

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

Rx