Background: Cirrhosis affects millions of people throughout the world. Patients with cirrhosis frequently develop renal failure. Hepatorenal syndrome (HRS) develops in decompensated liver disease and it is considered to be the most severe complication. It is the most frequent fatal complication of cirrhosis with nearly 50% of patients dying within 2 weeks of diagnosis. Aim of work: The aim of the study is to compare between the effect of Terlipressin and norepinephrine in the management of type I hepatorenal syndrome. Patient & methods: A prospective randomized controlled study. This study was held in Ain Shams University hospitals. 6 months from February to July 2019. 40 patients were divided equally into two groups (20 for each group). Result: This study comprised 40 patients with Type I hepatorenal syndrome admitted during the period of research from February 2019 to July 2019 to Ain Shams University hospitals. All patients have acute or chronic liver diseases with type I hepatorenal syndrome, and the patients were divided into two groups. Conclusion: The results of this randomized comparative study suggest that norepinephrine and terlipressin had nearly similar response rates for the treatment of type 1 HRS. Therefore, norepinephrine is as effective as terlipressin in the management of patients with type 1 HRS. The lower cost and wider availability of norepinephrine make it a safe and effective alternative to terlipressin. Recommendations: The present study shows that norepinephrine is as effective as terlipressin in the management of patients with type 1 HRS in order to save costs and ICU beds. This study provides the basis for designing larger randomized controlled trials to confirm the present findings. Further studies should also aim to identify predictors of nonresponsiveness.