Glypressin (Terlipressin Acetate)

Glypressin is an injectable solution containing 1 mg of terlipressin acetate per 5 mL. It is a synthetic vasopressin analog classified as a vasoconstrictor and anti‑hemorrhagic agent. Marketed in the European Union and available by prescription only, Glypressin is administered intravenously to target V1 receptors, producing selective vasoconstriction that lowers portal venous pressure. The product is used under medical supervision in hospital clinical and intensive care settings.

Glypressin is indicated for several acute conditions related to portal hypertension and systemic vasodilation.

- Acute variceal bleeding associated with portal hypertension. - Hepatorenal syndrome in patients with advanced liver disease. - Management of severe portal hypertension when endoscopic therapy is insufficient. - Controlled hypotension during certain surgical procedures. - Prevention of re‑bleeding after initial control of variceal hemorrhage. - Adjunct therapy in septic shock with refractory hypotension (off‑label, clinical practice).

The safety profile of Glypressin reflects its vasoconstrictive activity; side effects are reported across a range of frequencies.

Common: - Headache, often mild and self‑limiting. - Nausea or vomiting, usually transient. - Transient rise in systolic blood pressure, typically resolves without intervention. - Flushing or warmth sensation at the infusion site.

Serious: - Myocardial ischemia or infarction, especially in patients with pre‑existing coronary disease. - Severe hypertension that may precipitate cerebrovascular events such as stroke. - Ischemic necrosis of skin, digits or other peripheral tissues due to intense vasoconstriction. - Cardiac arrhythmias, including ventricular tachycardia, reported in rare cases.

When prescribing Glypressin, clinicians should evaluate patient history and monitor for specific risks associated with potent vasoconstriction.

- Known cardiovascular disease (e.g., coronary artery disease, uncontrolled hypertension). - Recent myocardial infarction or stroke. - Peripheral vascular disease or Raynaud phenomenon. - Severe renal impairment. - Pregnancy and lactation status (safety not established). - Concomitant use of other vasopressors.

Glypressin may alter the effects of other medications that influence vascular tone, cardiac function, or renal perfusion.

Avoid: - Other vasopressin analogs or potent vasoconstrictors (e.g., norepinephrine, phenylephrine). - Monoamine oxidase inhibitors (risk of hypertensive crisis).

Use with caution: - Beta‑blockers (may mask tachycardia). - Diuretics (potential for excessive volume depletion). - ACE inhibitors or ARBs (altered blood pressure response). - Antifungal azoles (possible pharmacokinetic interaction).