Terlipressin in the management of liver disease

ABSTRACT

Introduction

Terlipressin is a synthetic vasopressin analog which has been recently approved in the United States by the Food and Drug Administration for the treatment of hepatorenal syndrome. Terlipressin stimulates vasopressin receptors located on the smooth muscle vasculature of the splanchnic circulation and renal tubules which results in splanchnic vasoconstriction with improved renal perfusion and antidiuretic activity, respectively.

Areas covered

In this review, we discuss available data regarding the FDA approved use of terlipressin, safety, and tolerability, as well as highlight alternative uses in chronic liver disease currently still under investigation.

Expert opinion

Terlipressin is more efficacious compared to other vasoactive agents including midodrine octreotide and norepinephrine in reversal of hepatorenal syndrome and improves short-term survival. Other potential applications of terlipressin’s vasoconstrictor actions reported in the literature include management of variceal hemorrhage and other complications of portal hypertension.

KEYWORDS:

• Acute-on-chronic liver failure
• hepatorenal syndrome – 1
• hepatorenal syndrome-acute kidney injury
• terlipressin
• vasopressin

Article highlights

• Terlipressin is a synthetic vasopressin analog which acts on vasopressin receptors in the splanchnic circulation to induce vasoconstriction as well as in the renal tubules to increase water reabsorption and improve circulatory volume.

• Terlipressin is now FDA-approved for the treatment of HRS-acute kidney injury in the United States.

• Once a diagnosis of HRS is established, terlipressin should be used as first-line treatment in accordance with AASLD and EASL guidelines.

• Terlipressin has superior efficacy compared to midodrine and octreotide in the treatment of HRS-AKI.

• Benefits of terlipressin administration have also been described in variceal hemorrhage and other complications of portal hypertension.

Declaration of interest

P Martin previously served as a consultant to Mallinckrodt. J. A. Turkeltaub serves on an advisory board for Grifols. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.