UNC Health

     System Formulary Restriction:

     Use of terlipressin injection is restricted to patients that meet all of the following:

• Known or suspected HRS-AKI
• HRS-AKI has been managed by volume resuscitation (e.g., albumin) +/- diuretic withdrawal x48 hours prior to first terlipressin dose
• SpO2 ≥90% on room air at first dose; terlipressin must be d/c’ed if SpO2 drops below 90% on room air  
• Pre-treatment, patient meets at least 1 of the following criteria for AKI and SCr is <5 mg/dL              
  • Increase in SCr ≥ 0.3 mg/dL within 48 hours, or
  • SCr increase ≥50% from baseline, assumed or known to have occurred over last 7 days
• Patient is not currently requiring circulatory support with other vasopressor agents 
• Cannot be used in patients with acute liver failure, acute-on-chronic liver failure (ACLF) Grade 3, or MELD ≥35
• Cannot be used for variceal hemorrhage
• Max 14 days of therapy 

     UNC Health IV Compendium Guideline

Med Center
     UNC Medical Center Formulary Restrictions

• Lexicomp
• Micromedex
• UpToDate
• FDA Daily Med