Objective To investigate the clinical efficiency and adverse effects of terlipressin on septic shock in very old patients(≥80 years old). Methods Thirty-six very old septic shock patients hospitalized in our department from January 2010 to January 2013 were randomly divided into 2 groups. Eighteen patients in group A were treated with dopamine first, and then the ineffective patients received alternative terlipressin treatment. The other eighteen patients in group B were treated with terlipressin. Their heart rate, mean arterial pressure(MAP), urine volume, and shock index before and at 24h after treatment, and blood urea nitrogen and creatinine at 3d after treatment were observed and recorded. The efficiency and adverse effects were also compared and analyzed. Results After treatment, dopamine was effective for 10 cases in group A, and the left 8 ineffective patients in group A who received alternative terlipressin treatment got significantly elevated MAP, declined shock index, and raised heart rate(P＜0.05). In group B, the similar change was observed in the changes of MAP and shock index, but not in the heart rate, and all these were significantly different with those in group A(P＜0.05). There was no significant difference in the raised urine volumes between the 2 groups(P＞0.05). At 3d after treatment, the renal function of all the patients had no obvious change. Two patients in group B were observed with bedsore. None of adverse effects was observed in the other patients. Conclusion Terlipressin is superior to dopamine in treatment of septic shock in very old patients(≥80 years old), and has a good prospect of clinical application in septic shock treatment.