Background: Hepatorenal syndrome (HRS) is characterized by functional renal failure in advanced liver disease. HRS can be treated using a variety of vasoconstrictors. The preferred medication for treating type 1 HRS (HRS-1) is terlipressin, it is costly and frequently difficult to obtain. the alpha-adrenergic medication noradrenaline may be beneficial in HRS. Objectives: Evaluate the efficacy of noradrenaline versus terlipressin in the treatment of HRS-1 in order to minimize cost of treatment. Patients and methods: Fifty cirrhotic individuals with HRS-1 were included in the study. The patients were divided randomly into two groups as follows: Group (A) Terlipressin (0.5-2 mg/6h) plus human albumin were used to treat 25 patients. Group (B): 25 patients were managed with noradrenaline (0.5-3 mg/h) plus human albumin. Results: The initial traits of the two groups were comparable. The HRS reversed in 44% (11/25; p=0.571) of group B patients and 52% (13/25) of group A patients. Serum creatinine levels in both groups significantly decreased from baseline, with group A dropping from 2.88 ± 0.68 mg/dl to 2.16 ± 1.00 mg/dl and group B from 2.71± 0.67 mg/dl to 2.07 ± 1.21 mg/dl (p 0.023 and p 0.038, respectively). A reduced baseline creatinine level was a reliable indicator of treatment response. In conclusion, noradrenaline, despite being less expensive, is equally efficient and secure in treating HRS type 1 as terlipressin.