Varipress
Generic Name
varipress-1-mg-injection
Manufacturer
Ferring Pharmaceuticals
Country
Switzerland
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| varipress 1 mg injection | ৳ 1,710.00 | N/A |
Description
Overview of the medicine
Terlipressin (Varipress) is a synthetic analogue of vasopressin primarily used for the treatment of acute bleeding from esophageal varices and Type 1 Hepatorenal Syndrome (HRS). It works by causing vasoconstriction in the splanchnic circulation, thereby reducing portal pressure and stopping bleeding.
Uses & Indications
Dosage
Adults
Bleeding Esophageal Varices: Initial dose 2 mg IV bolus over 3 minutes, followed by 1-2 mg IV every 4-6 hours. Maximum daily dose 12 mg. Hepatorenal Syndrome: Initial dose 0.85 mg IV bolus every 6 hours for 3 days, increasing to 1.7 mg every 6 hours if serum creatinine doesn't decrease.
Elderly
Use with caution due to increased risk of cardiovascular adverse events. No specific dosage adjustment recommended, but closer monitoring is advised.
Renal_impairment
No specific dosage adjustment for mild to moderate impairment. Use with caution in severe renal impairment, with close monitoring.
How to Take
Administer by slow intravenous (IV) bolus injection over 3 minutes. Reconstitute the powder with the provided solvent according to manufacturer's instructions. Do not mix with other medications.
Mechanism of Action
Terlipressin is a prodrug that is slowly cleaved by endopeptidases to release its active metabolite, lysine-vasopressin. This active form selectively acts on V1 vasopressin receptors located in the smooth muscle of the splanchnic circulation, leading to intense vasoconstriction. This reduces portal venous inflow and pressure, making it effective in controlling variceal bleeding. It also improves systemic hemodynamics in Hepatorenal Syndrome.
Pharmacokinetics
Onset
Hemodynamic effects typically begin within minutes of administration.
Excretion
Mainly excreted via the kidneys as inactive metabolites and active lysine-vasopressin. Less than 1% is excreted unchanged in urine.
Half life
Terlipressin: 50-60 minutes. Active metabolite (lysine-vasopressin): Approximately 6 hours.
Absorption
Administered intravenously, resulting in 100% bioavailability.
Metabolism
Terlipressin is a prodrug, enzymatically cleaved by endopeptidases to form the active metabolite lysine-vasopressin.
Side Effects
Contraindications
- Hypersensitivity to terlipressin or any excipients
- Pregnancy (known or suspected)
- Uncontrolled hypertension
- Severe coronary artery disease, angina pectoris, or recent myocardial infarction
- Epilepsy, severe asthma, chronic obstructive pulmonary disease
- Advanced chronic kidney disease (for HRS indication, specific contraindications apply)
Drug Interactions
Beta-blockers
Increased risk of bradycardia and hypotension.
Sympathomimetics
May enhance vasoconstrictor effects.
Hypotensive drugs
Increased risk of severe hypotension when combined.
Drugs inducing bradycardia (e.g., Propofol, Sufentanil)
Enhanced bradycardic effect.
Drugs prolonging QT interval (e.g., Amiodarone, Quinidine)
Increased risk of ventricular arrhythmias; caution advised.
Storage
Store in a refrigerator (2°C - 8°C). Protect from light. Do not freeze. Reconstituted solution should be used immediately and not stored.
Overdose
Symptoms of overdose may include severe bradycardia, hypertension, pallor, abdominal pain, diarrhea, and potentially cardiac arrhythmias or myocardial ischemia. Treatment is symptomatic and supportive. For severe hypertension, an alpha-blocker (e.g., phentolamine) may be administered. Nitrates may be used for chest pain due to myocardial ischemia.
Pregnancy & Lactation
Contraindicated in pregnancy due to its oxytocic effects, which can cause uterine contractions and reduce placental blood flow, potentially harming the fetus. Use during lactation is generally not recommended as it's unknown if terlipressin or its metabolites are excreted in human milk; the risk/benefit must be carefully considered.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Usually 2-3 years when stored correctly. Refer to the specific product packaging for exact expiry date.
Availability
Hospitals, Specialized pharmacies
Approval Status
Approved
Patent Status
Off-patent
WHO Essential Medicine
YesClinical Trials
Numerous clinical trials have established the efficacy and safety of terlipressin in the management of bleeding esophageal varices and Type 1 Hepatorenal Syndrome. Studies have shown its superiority over placebo and other treatments in controlling bleeding and improving survival rates in these conditions.
Lab Monitoring
- Cardiac monitoring (ECG)
- Blood pressure monitoring
- Serum electrolytes (especially sodium and potassium)
- Renal function tests (serum creatinine, BUN)
- Fluid balance monitoring
- Peripheral perfusion assessment
Doctor Notes
- Crucial for cardiovascular monitoring (ECG, BP) throughout treatment due to risk of ischemic events.
- Monitor fluid and electrolyte balance carefully, particularly serum sodium, to prevent hyponatremia.
- Use with extreme caution in patients with pre-existing cardiovascular disease, severe renal impairment, or severe respiratory conditions.
Patient Guidelines
- Varipress is administered in a hospital setting under constant medical supervision.
- Report any new or worsening symptoms immediately, especially chest pain, shortness of breath, sudden weakness, or changes in skin color.
- Inform healthcare providers about all other medications, supplements, and pre-existing medical conditions, particularly heart or kidney problems.
Missed Dose Advice
As Varipress is administered in a hospital setting for acute conditions under strict medical supervision, a missed dose is highly unlikely. If a dose is inadvertently missed, the medical team will assess and administer it as soon as clinically appropriate.
Driving Precautions
Not applicable, as this medication is administered in acute hospital settings and can cause significant side effects that impair the ability to drive or operate machinery.
Lifestyle Advice
- This medication is for acute hospital treatment; lifestyle advice is focused on managing the underlying liver disease after discharge. Avoid alcohol.
- Follow your doctor's recommendations for diet and fluid intake related to liver and kidney health.
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