Terlipressin acetate is primarily used in the treatment of acute variceal bleeding, a serious complication of portal hypertension often seen in patients with liver cirrhosis. It acts as a vasopressin analog, causing selective splanchnic vasoconstriction, which reduces portal pressure and helps control bleeding from esophageal varices. It is often used as a first-line pharmacological therapy alongside endoscopic treatment. It is also employed in the management of hepatorenal syndrome, particularly type 1, where it improves renal function by increasing effective arterial blood volume and enhancing renal perfusion when combined with albumin. Its prolonged half-life compared to vasopressin allows for less frequent dosing and more stable hemodynamic effects. Additionally, terlipressin acetate has been investigated for use in septic shock and other vasodilatory shock states due to its ability to restore vascular tone and improve blood pressure in patients unresponsive to conventional vasopressors.