Terlipressin has Stood the Test of Time

Clinical Overview in 2020 and Future Perspectives

Anand V. Kulkarni; Juan Pablo Arab; Madhumita Premkumar; Carlos Benítez; Sowmya Tirumalige Ravikumar; Pramod Kumar; Mithun Sharma; Duvvuru Nageshwar Reddy; Douglas A. Simonetto; Padaki Nagaraja Rao


Liver International. 2020;40(12):2888-2905. 

In This Article


Terlipressin is an effective drug for HRS reversal in cirrhotics and ACLF patients. Adverse effects are common with terlipressin and need to be monitored strictly. Terlipressin is also effective in controlling acute variceal bleed with a mortality benefit. It has been widely accepted for use in HRS and acute variceal bleeding. There is some evidence to support the use of this drug in a judicious fashion in scenarios like refractory ascites, hepatic hydrothorax, septic shock, acute liver failure, paracentesis-induced circulatory dysfunction and perioperatively during liver transplantation and hepatobiliary surgeries. However, more extensive randomised controlled trials with adherence to CONSORT guidelines are required before recommending terlipressin for such indications. The severity of the liver disease, as assessed by the MELD score and Child-Pugh score, predicts the response to terlipressin in HRS and AVB. Selection of patients is crucial to prevent complications in the elderly, those with pre-existing coronary artery disease or arrhythmias, peripheral vascular disease and chronic airway disease. Given these expanding indications and new evidence to support the use of terlipressin, as shown in this comprehensive review, it is time to renew our interest in this remarkable drug.