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System Formulary Update
Terlipressin (terlivaz)

Situation

Terlipressin (Terlivaz) is a high-risk medication that must be appropriately prescribed and monitored.

Background

Terlipressin is a vasopressin antagonist indicated to improve kidney function in patients with HRS-AKI. It is dosed q6h for up to 14 days. Terlipressin was approved for formulary addition by System P&T in February 2023.

While terlipressin improves renal response in eligible patients, safe and appropriate administration requires the following:

• Careful patient selection based on parameters such as baseline SCr, comorbidities, and pregnancy status
• Daily SCr monitoring to measure response and drive dose adjustments on Day 3 (or, if no response, dose discontinuation)
• Continuous pulse oximetry monitoring to ensure SpO2 does not drop below 90% on RA
• Close monitoring of respiratory status and ischemic sequelae, which would be cause for prompt discontinuation.

Assessment/Recommendations

An order panel is required to ensure appropriate pre- and intra-therapy monitoring is performed, and that appropriate patient selection/dosing is selected. 

Create order panel; include order questions on medication ERX to ensure formulary restriction compliance.

Formulary/Epic changes will Go-Live on Tuesday, May 23, 2023.