Supplementary Material for: Severe bradycardia associated with the use of terlipressin – a case report

Although terlipressin is known to cause bradycardia, this adverse effect is usually described in association with hypertension, and is considered a benign compensatory response mediated by arterial baroreceptors. Cardiac monitoring for patients receiving terlipressin is not routinely recommended. We report a case of severe sinus bradycardia following the use of terlipressin in an elderly patient, which was associated with significant hypotension that required the infusion of norepinephrine. This bradycardia was observed in a patient with no history of coronary artery disease and no other coexisting risk factors for cardiac arrhythmias or conduction disturbances. Vasopressin is known to sensitize baroreceptor reflexes by a central mechanism though its actions on V1a receptors in the area postrema, and we speculate that vasopressin analogues such as terlipressin may act in the same manner. That this effect is not widely described in terlipressin safety literature may be due to the overall younger age range of the trial population. This raises the possibility that cardiac monitoring may be warranted for elderly patients receiving terlipressin.