Prodrug of lysine-vasopressin that constricts the vessels of the digestive territory. Used in hepatorenal syndrome (kidney failure in cirrhosis) and in bleeding from esophageal varices.
FDA (US): Approved (2022, Terlivaz) to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function
EMA (EU): No centralized authorization; authorized through national procedures in EU countries (in Spain, Glypressin and generics) for esophageal variceal bleeding and, depending on the product, hepatorenal syndrome
Dose
Hepatorenal syndrome: 0.85 mg intravenously every 6 hours for 3 days; depending on creatinine, it is continued or increased to 1.7 mg every 6 hours, up to a maximum of 14 days (FDA label Terlivaz 2022). Usually combined with albumin.
Safety
Abdominal pain, nausea, diarrhea, and shortness of breath. Serious risk of respiratory failure, especially with fluid overload or very impaired kidney function: the FDA lists it in a boxed warning. Also ischemia (cardiac, intestinal, in fingers or skin). Hospital use only.
Interactions
Greater risk of bradycardia with drugs that lower heart rate (beta-blockers, propofol, sufentanil). Monitor with other drugs that prolong the QT interval.
Differences between women and men
It can cause uterine contractions and reduce blood flow to the uterus; the label warns of risk of fetal harm and miscarriage, so it is avoided in pregnancy.
Effect by goal · level of evidence
Reversal of type 1 hepatorenal syndrome
improvesModerateRCT (AA)in people
32% vs 17% reversal
CONFIRM trial with 300 patients. Verified reversal was achieved in 32% with terlipressin plus albumin vs 17% with placebo plus albumin. There were more deaths from respiratory causes at 90 days (11% vs 2%) and survival did not improve.
In the body it is gradually converted into lysine-vasopressin. It activates V1 receptors in the abdominal blood vessels and constricts them. This lowers pressure in the portal vein and redistributes blood, which improves blood flow to the kidney in advanced cirrhosis and reduces variceal bleeding.
What the evidence says
In people
Reversal of type 1 hepatorenal syndrome. CONFIRM trial with 300 patients. Verified reversal was achieved in 32% with terlipressin plus albumin versus 17% with placebo plus albumin. There were more deaths from respiratory causes at 90 days (11% versus 2%) and survival did not improve. PubMed 33657294