• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or nurse.
• If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Terlipressin acetate 0.12 mg/ml solution for injection is and what it is used for
2. What you need to know before you are given Terlipressin acetate 0.12 mg/ml solution for injection
3. How to use Terlipressin acetate 0.12 mg/ml solution for injection
4. Possible side effects
5. How to store Terlipressin acetate 0.12 mg/ml solution for injection
6. Contents of the pack and other information

• if you are allergic to terlipressin or any of the other ingredients of this medicine (listed in section 6).

This medicine will be given to you if you have severe or life-threatening bleeding in your food pipe (oesophagus). It is used under continuous monitoring of your heart and blood circulation.

If you are able to, tell your doctor if you suffer from the conditions shown below:

• if you are suffering from a severe infection known as septic shock
• if you suffer from bronchial asthma or other conditions that affect your breathing
• if you suffer from acute coronary syndrome (ACS describes symptoms related to poor blood flow to the heart muscle leading to a heart attack. This results in chest pain, or angina pectoris.)
• if you suffer from uncontrolled high blood pressure, insufficient blood circulation in the heart vessels (e.g. angina), have previously had a heart attack (myocardial infarction), or you have hardening of your arteries (arteriosclerosis)
• if you suffer from irregular heartbeats (cardiac arrhythmias)
• if you have poor blood circulation to your brain (e.g. you have had a stroke) or to your limbs (peripheral vascular disease)
• if you suffer from impaired kidney function (renal insufficiency)
• if you suffer from disturbances in the level of salt (electrolytes) in your blood
• if you are suffering from 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 you are pregnant.

Terlipressin acetate 0.12 mg/ml solution for injection is not recommended for use in children and adolescents due to insufficient experience.

Tell your doctor or nurse if you are taking, have recently taken or might take any other medicines.

Please inform your doctor immediately if you use the following medicines:

• drugs that have an effect on your heart rate (e.g. beta-blockers or propofol)
• drugs that can trigger irregular beating of the heart (arrhythmia) such as the following:
  • anti-arrhythmic drugs known as Class IA (quinidine, procainamide, disopyramide) and Class III (amiodarone, sotalol, ibutilide, dofetilide)
  • an antibiotic called erythromycin
  • antihistamines (mainly used to treat allergies but also found in certain cough and cold remedies)
  • medicines used to treat depression called tricyclic antidepressants
  • medicines that may alter the level of salt or electrolytes in your blood, particularly diuretics (used to treat high blood pressure and heart failure).

Terlipressin acetate 0.12 mg/ml solution for injection should only be used during pregnancy if it is vital to treat your condition. If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before you are given this medicine.

It is not known if Terlipressin acetate 0.12 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.

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.

This medicinal product contains 15.7 mmol (or 361 mg) sodium per dose. To be taken into consideration by patients on a controlled sodium diet.

Adults

Initially 1-2 mg terlipressin acetate (equivalent to 8.5-17 ml of injection solution) 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 (equivalent to 8.5 ml of solution), every 4 to 6 hours.

The maximum dose you can receive each day is approximately 120 micrograms/kg body weight.

Elderly

If you are over 70 years of age speak with your doctor before you receive Terlipressin acetate 0.12 mg/ml solution for injection.

Terlipressin acetate 0.12 mg/ml solution for injection should be slowly injected intravenously.

The use is limited to 2 – 3 days, depending on the course of your condition.

You must not have more Terlipressin acetate 0.12 mg/ml solution for injection than the recommended dose. If you are given too much then you may have a rapid increase in your blood pressure, especially if you already suffer with high blood pressure. If this happens then you need 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 as these could be signs of a low heart rate. This can be treated with a medicine called atropine.

You will be given Terlipressin acetate 0.12 mg/ml solution for injection in hospital under the supervision of your doctor.

If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

In very rare cases severe side effects are possible when you are given terlipressin. If you are affected by one of the following side effects, please tell your doctor immediately if you are able to. Your doctor should not give you any more terlipressin.

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 heartbeats, locally dead skin (necrosis), convulsions (seizure), kidney failure.

Common (may affect up to 1 in 10 people)

• headache
• too slow heart rate
• signs of insufficient blood circulation in the heart vessels shown in the ECG
• high blood pressure
• low blood pressure
• insufficient blood circulation in arms, legs and skin, pale skin
• abdominal cramps
• diarrhoea.

Uncommon (may affect up to 1 in 100 people)

• too little sodium in the blood (hyponatraemia) if not monitored
• dead skin (necrosis) not related to the injection site
• rapid increase in blood pressure
• too fast heart rate (palpitations)
• swelling of the tissues in the body or fluid on the lungs
• chest pain
• heart attack
• excess fluid on the lungs
• heart failure (Torsade de Pointes)
• insufficient blood flow to the intestines
• uterine cramps
• decreased blood flow to the uterus
• bluish colouration of the skin or lips
• hot flushes
• temporary nausea (feeling sick)
• temporary vomiting
• inflammation of the lymph vessels (fine red streaks under your skin extending from the affected area to the armpit or groin and by fever, chills, headache, and muscle pain).

Rare (may affect up to 1 in 1,000 people)

• shortness of breath.

Very rare (may affect up to 1 in 10,000 people)

• too much sugar in the blood (hyperglycaemia)
• stroke.

Not known (frequency cannot be estimated from the available data)

• uterine cramps (cramps in the womb)
• decreased blood flow to the uterus.

If you get any side effects, talk to your doctor, 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 at: www.mhra.gov.uk/yellowcard.

By reporting side effects you can help provide more information on the safety of this medicine.

• The active substance is terlipressin (as acetate). Each ampoule contains 1 mg of terlipressin acetate in 8.5 ml solution for injection, corresponding to 0.85 mg terlipressin. This is equivalent to 0.12 mg terlipressin acetate per ml, corresponding to 0.1 mg terlipressin per ml.
• The other ingredients are sodium acetate trihydrate, sodium chloride, acetic acid, glacial (for pH adjustment) and water for injection.

Terlipressin acetate 0.12 mg/ml solution for injection is a clear, colourless solution for injection without visible particles.

Terlipressin acetate 0.12 mg/ml solution for injection is packed into one carton with 5 ampoules.