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TERLIPRESSIN ACETATE EVER PHARMA 0.2 MG/ML SOLUTION FOR INJECTION

Active substance(s): TERLIPRESSIN ACETATE

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Package leaflet: Information for the patient

Terlipressin acetate EVER Pharma
0.2 mg/ml solution for injection
Read all of this leaflet carefully before you are given this medicine because it contains important
information for you.
- Keep this leaflet. You may need to read it again.
- If you have any further questions, ask your doctor or pharmacist.
- If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side
effects not listed in this leaflet. See section 4.
What is in this leaflet
1. What Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection is and what it is used for
2. What you need to know before you are given Terlipressin acetate EVER Pharma 0.2 mg/ml solution for
injection
3. How Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection will be given
4. Possible side effects
5. How to store Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection
6. Contents of the pack and other information

2. WHAT YOU NEED TO KNOW BEFORE YOU ARE GIVEN TERLIPRESSIN ACETATE EVER
PHARMA 0.2 MG/ML SOLUTION FOR INJECTION
You should not receive Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection:
- If you are allergic (hypersensitive) to terlipressin or any of the other ingredients of this medicine (listed
in section 6)
- If you are pregnant.
Warnings and precautions
Talk to your doctor, pharmacist or nurse before you are given Terlipressin acetate EVER Pharma 0.2 mg/
ml solution for injection:
- If you have a severe infection known as septic shock
- If you have bronchial asthma or other conditions that affect your breathing
- If you have uncontrolled high blood pressure, insufficient blood circulation in the heart vessels (e.g. angina)
- If you have previously had a heart attack (myocardial infarction), or you have hardening of the arteries
(arteriosclerosis)
- If you have irregular heart beats (cardiac arrythmias) or a history of QT interval prolongation (disturbance
of heart rhythm)
- If you have a poor blood circulation to your brain (e.g. you have had a stroke) or to your limbs
(peripheral vascular disease)
- If you have an impaired kidney function (renal insufficiency)
- If you have disturbances in the level of salt (electrolytes) in your blood
- If you have reduced amount of fluid in your circulation or have already lost a large amount of blood
- If you are over the age of 70 years.
If any of the above apply to you (or you are not sure), talk to your doctor, pharmacist or nurse before you
are given Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection.
During treatment with Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection your blood
pressure, heart rate and fluid balance should be monitored constantly.
Children and adolescents
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injectionis not recommended for use in children
and adolescents due to insufficient experience.
Other medicines and Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection
Tell your doctor, pharmacist or nurse if you are taking, have recently taken or might take any other medicines.
Please inform your doctor immediately if you take any of the following medicines:
- drugs that have an effect on your heart rate (e.g. beta-blockers, sufentanil or propofol)
- drugs that can trigger irregular beating of the heart (arrhythmia) such as the following:
• anti-arryhthmic drugs known as Class IA (quinidine, procainamide, disopyramide) and Class III
(amiodarone, sotalol, ibutilide, dofetilide)
• erythromycin (an antibiotic)
• antihistamines (mainly used to treat allergies but also found in certain cough and cold remedies)
• tricyclic antidepressants used to treat depression
• medicines that may alter the level of salt or electrolytes in your blood, particularly diuretics (water
tablets used to treat high blood pressure and heart failure)
Pregnancy and breast-feeding
Tell your doctor if you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby.
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection must not be used during pregnancy.
It is not known if Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection is present in breast
milk, therefore the possible effects on your baby are unknown. You should discuss the potential risk to
your baby with your doctor.
Driving and using machines
No studies on the effects on the ability to drive and use machines have been performed. However, if you
feel unwell after receiving the injection, do not drive or operate machinery.
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection contains sodium
This medicinal product contains 0.8 mmol (18.4 mg) of sodium per 5 ml and 1.6 mmol (36.8 mg) of
sodium per 10 ml. To be taken into consideration by patients on a controlled sodium diet.

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3. HOW TERLIPRESSIN ACETATE EVER PHARMA 0.2 MG/ML SOLUTION FOR INJECTION WILL
BE GIVEN
This medicine will always be given to you by a doctor into your vein. The doctor will decide the most
appropriate dose for you and your heart and blood circulation will be continuously monitored during the
injection. Please ask your doctor for further information regarding its use.
Use in adults
1. Short term management of bleeding oesophageal varices
Initially 1-2 mg terlipressin acetate (5-10 ml of Terlipressin acetate EVER Pharma 0.2 mg/ml solution for
injection) is given by injection into your vein. Your dose will depend on your body weight.
After the initial injection, your dose may be reduced to 1 mg terlipressin acetate (5 ml) every 4 to 6 hours.
2. Type 1 hepatorenal syndrome
The usual dose is 1 mg terlipressin acetate every 6 hours for at least 3 days. If the reduction of serum
creatinine is less than 30 % after 3 days of treatment your doctor should consider doubling the dose to
2 mg every 6 hours.
If there is no response to Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection or in patients
with complete response, treatment with Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection
should be interrupted.
When a reduction in serum creatinine is seen, treatment with Terlipressin acetate EVER Pharma 0.2 mg/ml
solution for injection should be maintained to a maximum of 14 days.
Use in the elderly
If you are over 70 years of age speak with your doctor before you receive Terlipressin acetate EVER
Pharma 0.2 mg/ml solution for injection.
Use in patients with kidney problems
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection should be used with caution in patients
with long standing kidney failure.
Use in patients with liver problems
No dose adjustment is required in patients with liver failure.
Use in children and adolescents
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection is not recommended for use in children
and adolescents due to insufficient experience.
Duration of treatment
The use of this medicine is limited to 2 – 3 days for short term management of bleeding oesophageal
varices and to a maximum of 14 days for treatment of type 1 hepatorenal syndrome, depending on the
course of your condition.
If you are given more Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection than you should
As this medicine is given by a healthcare professional, it is unlikely you will be given more than the
recommended dose. If you are given too much you may have a rapid increase in your blood pressure (this
will be noticed during the continuous monitoring), especially if you already suffer with high blood pressure.
If this happens then you will be given another medicine called an alpha blocker (e.g. clonidine) to control
your blood pressure.
If you experience lightheadedness, dizziness, or feeling faint, tell your doctor because these could be
signs of a low heart rate. This can be treated with another medicine called atropine.
If you stop using Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection
Your doctor will advise when it is time to stop receiving this medicine.
If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.
4. POSSIBLE SIDE EFFECTS
Like all medicines, this medicine can cause side effects, although not everybody gets them.
Important side effects which need immediate attention:
In very rare cases, there may be severe side effects when you are given Terlipressin acetate EVER Pharma
0.2 mg/ml solution for injection.

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1. WHAT TERLIPRESSIN ACETATE EVER PHARMA 0.2 MG/ML SOLUTION FOR INJECTION IS
AND WHAT IT IS USED FOR
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection contains the active ingredient
terlipressin, which is a synthetic pituitary hormone (this hormone is usually produced by the pituitary
gland found in the brain).
It will be given to you by injection into a vein.
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection is used for the treatment of:
• bleeding from dilated (widening) veins in the food pipe leading to your stomach (called bleeding
oesophageal varices).
• emergency treatment of type 1 hepatorenal syndrome (rapidly progressive renal failure) in patients with
liver cirrhosis (scarring of the liver) and ascites (abdominal dropsy).

5. HOW TO STORE TERLIPRESSIN ACETATE EVER PHARMA 0.2 MG/ML SOLUTION FOR INJECTION
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton and the vial after ‘EXP’. The
expiry date refers to the last day of that month.
Store in a refrigerator (2˚C-8°C). Do not freeze.
Keep the vial in the outer carton. The solution should be inspected visually for particles and discolouration
prior to administration. The medicine must not be used if any notice discoloration is noticed. Medicines
should not be disposed via wastewater or household waste. The doctor will dispose of this medicine.
These measures will help protect the environment.
6. CONTENTS OF THE PACK AND OTHER INFORMATION
What Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection contains
- the active substance is terlipressin acetate.
5 ml of injection solution contains 1 mg terlipressin acetate corresponding to 0.85 mg terlipressin.
10 ml of injection solution contains 2 mg terlipressin acetate corresponding to 1.7 mg terlipressin.
This is equivalent to 0.2 mg terlipressin acetate per ml, corresponding to 0.17 mg terlipessin per ml.
- the other ingredients are: Sodium chloride, acetic acid, sodium hydroxide (for pH-adjustment),
hydrochloric acid (for pH-adjustment) and water for injections
What Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection looks like and contents of
the pack
This medicine is supplied in a clear glass vial containing 5 ml or 10 ml of a clear, colourless solution.
This medicine is available in pack sizes of: 1 x 5 ml, 5 x 5 ml, 1 x 10 ml, 5 x 10 ml
Marketing Authorisation Holder
EVER Valinject GmbH
Oberburgau 3
4866 Unterach
Austria
Manufacturer
EVER Pharma Jena GmbH
Otto-Schott-Strasse 15
07745 Jena
Germany
This medicinal product is authorised in the Member States of the EEA under the following names:
List of proposed (invented) names and marketing authorisation holders in the concerned member states
AT
Terlipressinacetat EVER Pharma 0,2 mg/ml Injektionslösung
CZ
Terlipresin acetát EVER Pharma 0,2 mg/ml injekční roztok
DE
Terlipressinacetat EVER Pharma 0,2 mg/ml Injektionslösung
ES
Terlipresina acetato EVER Pharma 0,2 mg/ml solución inyectable EFG
FR
Acétate de terlipressine EVER Pharma 0,2 mg/ml solution injectable
IT
Terlipressina acetato EVER Pharma 0.2 mg/ml soluzione inettabile
PL
Terlipressini acetas EVER Pharma
RO
Terlipressin acetat EVER Pharma 0,2 mg/ml soluţie injectabilă
SK
Terlipresíniumacetát EVER Pharma 0,2 mg/ml injekčný roztok
UK
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection
This leaflet was last revised in September 2016

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The following information is intended for healthcare professionals only
Posology
1) Short term management of bleeding oesophageal varices:
Initial dose: 1 to 2 mg terlipressin acetate# (equivalent to 5 to 10 ml solution) is administered by
intravenous injection over a period of one minute.
Depending on the patient’s body weight the dose can be adjusted as follows:
• weight less than 50 kg: 1 mg terlipressin acetate (5 ml)
• weight 50 kg to 70 kg: 1.5 mg terlipressin acetate (7.5 ml)
• weight exceeding 70 kg: 2 mg terlipressin acetate (10 ml).
Maintenance dose: After the initial injection, the dose can be reduced to 1 mg terlipressin acetate every
4 to 6 hours.
#
1 to 2 mg terlipressin acetate corresponding to 0.85 to 1.7 mg terlipressin
The approximate value for the maximum daily dose of Terlipressin acetate EVER Pharma 0.2 mg/ml
solution for injectionis 120 micrograms in terlipressin acetate per kg body weight.
The therapy is to be limited to 2 to 3 days depending on the response to treatment and the course of the
disease.
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection is injected intravenously and should be
given over a period of one minute.
2) In type 1 hepatorenal syndrome:
An i.v. injection of 1 mg terlipressin acetate every 6 hours for at least 3 days. If after 3 days of treatment,
the decrease of serum creatinine is less than 30 % with respect to the baseline, doubling the dose to 2
mg every 6 hours will have to be considered.
Treatment with terlipressin should be interrupted if there is no response to treatment (defined as decrease
of serum creatinine is less than 30 % on day 7 with respect to baseline) or in patients with complete
response (values of serum creatinine below 1.5 mg/dl, for at least two consecutive days.
In patients showing an incomplete response (decrease of serum creatinine of at least 30 % with respect
to the baseline but without reaching a value below 1.5 mg/dl on day 7), treatment with terlipressin may be
maintained to a maximum of 14 days.
In most clinical studies supporting the use of terlipressin for the treatment of hepatorenal syndrome,
human albumin was administered simultaneously at a dosage of 1 g/kg BW on the first day and
afterwards at a dosage of 20 - 40 g/day.
The usual duration of the treatment of hepatorenal syndrome is 7 days, being the maximum duration
recommended 14 days.
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection should only be used with caution in
patients over 70 years, and patients with chronic renal failure.
Terlipressin acetate EVER Pharma 0.2 mg/ml solution for injection is not recommended in children and
adolescents due to insufficient experience on safety and efficacy.
A dose adjustment is not required in patients with liver failure.
Preparation of the injection
For administration, the required volume should be extracted from the vial with a syringe.
Store in a refrigerator (2˚C-8°C).Do not freeze.
Keep the vial in the outer carton.
For single use only. Discard any unused solution.
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If you are affected by any of the following side effects, please tell your doctor immediately if you are
able to. Your doctor should not give you any more Terlipressin acetate EVER Pharma 0.2 mg/ml solution
for injection.
• severe shortness of breath due to an asthma attack
• severe difficulty with or stopping breathing
• severe pain in the chest (angina)
• severe and persistent irregular heart beats
• dead skin around the injection site (necrosis)
• convulsions (seizure)
Other possible side effects:
Common (may affect up to 1 in 10 people):
• very slow heart rate
• signs of insufficient blood circulation in the heart vessels in the ECG
• high or low blood pressure
• insufficient blood circulation in arms, legs and skin
• paleness of face
• pale skin
• headache
• temporary abdominal cramps
• temporary diarrhoea
• abdominal cramps (in women)
Uncommon (may affect up to 1 in 100 people):
• chest pain
• rapid increase in blood pressure
• heart attack
• too fast heart rate (palpitations)
• swelling of the tissues in the body or fluid on the lungs
• bluish colouration of the skin or lips
• hot flushes
• excess fluid on the lungs
• temporary nausea
• temporary vomiting
• reduced blood supply to the intestinal system
• inflammation of the lymph vessels – seen as fine red streaks under your skin extending from the
affected area to the armpit or groin and by fever, chills, headache, and muscle pain
• too little sodium in the blood (hyponatraemia)
Rare (may affect up to 1 in 1,000 people):
• shortness of breath
• stroke
• too much sugar in the blood (hyperglycaemia)
Not known: frequency cannot be estimated from the available data
• heart failure
• Torsade de Pointes
• dead skin (necrosis) in areas other than at the injection site
• decreased blood flow to the uterus
• uterine cramps (cramps in the womb)
Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side
effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme
(Website: www.mhra.gov.uk/yellowcard). By reporting side effects you can help provide more information
on the safety of this medicine.

+ Expand Transcript

Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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