Terlipressin dose in hrs
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terlipressin dosing regimen hepatorenal syndrome variceal bleeding
Acute-on-Chronic Liver Failure and the Management of Critically Ill Patients with Cirrhosis
Page 35
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The search returned only reference citations without specific dosing details. Here is the complete terlipressin dosing based on standard guidelines:
Terlipressin Dosing
1. Hepatorenal Syndrome (HRS-AKI)
| Regimen | Dose | Frequency | Max Duration |
|---|---|---|---|
| Intermittent IV bolus | 0.5–1 mg | Every 4–6 hours | 14 days |
| Continuous IV infusion (preferred in some centers) | 2 mg/24 hrs (can titrate up to 12 mg/24 hrs) | Continuous | 14 days |
- Start: 1 mg IV every 6 hours (most common starting dose)
- Titration: If serum creatinine does not decrease by ≥25% from baseline after 2–3 days, increase to 2 mg every 6 hours
- Always given with albumin (20–40 g/day)
- Assess response at Day 3; discontinue if no improvement by Day 14
2. Variceal Bleeding (Esophageal)
| Dose | Frequency | Duration |
|---|---|---|
| 2 mg IV bolus (initial) | Every 4 hours | Up to 5 days |
| Maintenance: 1–2 mg | Every 4–6 hours | After initial control |
- Given as soon as variceal bleeding is suspected, prior to endoscopy
- Continue for 2–5 days post-endoscopy to prevent rebleeding
- Continuous infusion alternative: 2–4 mg/24 hrs
Key Points
- Contraindications: Severe cardiovascular disease, peripheral vascular disease, pregnancy, hyponatremia (Na <130 mEq/L — relative)
- Monitor: BP, heart rate, ECG, serum sodium, fluid balance, urine output
- Side effects: Hypertension, bradycardia, ischemia (cardiac, peripheral, mesenteric), skin necrosis at injection site
- For HRS: Combination with albumin is mandatory (EASL/AASLD guidelines)
Summary of key intervals: Terlipressin is dosed every 4 hours (variceal bleeding) or every 4–6 hours (HRS) when given as IV boluses.
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