Terlipressin (Glypressin) is indicated for the treatment of bleeding oesophageal varices and in some countries for the treatment of hepatorenal syndrome type 1. It is a prodrug and is converted to the lysine vasopressin in the circulation after the N-triglycyl residue is cleaved by endothelial peptidases. This results in a ‘slow release’ of the vasoactive lysine vasopressin. Terlipressin exerts its action by activating V1a, V1b and V2 vasopressin receptors. On September 14, 2022, the FDA granted approval to terlipressin (Terlivaz) for the treatment of adults hospitalized with hepatorenal syndrome with rapid reduction in kidney function (HRS-1). Prior to the approval, no approved treatment for this condition existed in the United States.
Approval Year
Targets
| Primary Target | Pharmacology | Condition | Potency |
|---|---|---|---|
Target ID: P37288 Gene ID: 552.0 Gene Symbol: AVPR1A Target Organism: Homo sapiens (Human) |
852.0 nM [Ki] | ||
Target ID: P47901 Gene ID: 553.0 Gene Symbol: AVPR1B Target Organism: Homo sapiens (Human) |
1115.0 nM [Ki] | ||
Target ID: P30518 Gene ID: 554.0 Gene Symbol: AVPR2 Target Organism: Homo sapiens (Human) |
1580.0 nM [Ki] |
Conditions
| Condition | Modality | Targets | Highest Phase | Product |
|---|---|---|---|---|
| Primary | TERLIVAZ Approved UseTERLIVAZ is a vasopressin receptor agonist indicated to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function. Launch Date2022 |
|||
| Primary | GLYPRESSIN Approved UseGLYPRESSIN is used to treat Bleeding Oesophageal Varices (BOV), bleeding veins inthe lower end of the food-pipe in people with serious liver disease. GLYPRESSIN is also used to treat hepatorenal syndrome, type 1 (HRS-1). |
Cmax
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
70.5 ng/mL |
1 mg 4 times / day multiple, intravenous dose: 1 mg route of administration: Intravenous experiment type: MULTIPLE co-administered: |
TERLIPRESSIN plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
|
1.16 ng/mL |
1 mg 4 times / day multiple, intravenous dose: 1 mg route of administration: Intravenous experiment type: MULTIPLE co-administered: |
LYPRESSIN plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
AUC
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
123 ng × h/mL |
1 mg 4 times / day multiple, intravenous dose: 1 mg route of administration: Intravenous experiment type: MULTIPLE co-administered: |
TERLIPRESSIN plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
|
11.2 ng × h/mL |
1 mg 4 times / day multiple, intravenous dose: 1 mg route of administration: Intravenous experiment type: MULTIPLE co-administered: |
LYPRESSIN plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
T1/2
| Value | Dose | Co-administered | Analyte | Population |
|---|---|---|---|---|
0.9 h |
1 mg 4 times / day multiple, intravenous dose: 1 mg route of administration: Intravenous experiment type: MULTIPLE co-administered: |
TERLIPRESSIN plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
|
3 h |
1 mg 4 times / day multiple, intravenous dose: 1 mg route of administration: Intravenous experiment type: MULTIPLE co-administered: |
LYPRESSIN plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
Doses
| Dose | Population | Adverse events |
|---|---|---|
3 mg 4 times / day steady, intravenous Highest studied dose Dose: 3 mg, 4 times / day Route: intravenous Route: steady Dose: 3 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: unknown Food Status: UNKNOWN Sources: |
Disc. AE: Death... AEs leading to discontinuation/dose reduction: Death (17.4%) Sources: |
1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: M+F Food Status: UNKNOWN Sources: |
Disc. AE: Death... Other AEs: Hepatic disorders, Respiratory failure... AEs leading to discontinuation/dose reduction: Death (50.8%) Other AEs:Hepatic disorders (33.3%) Sources: Respiratory failure (5.1%) Gastrointestinal hemorrhage (4.0%) Abdominal pain (1.0%) Haemodynamic edema, effusions and fluid overload (2.0%) |
1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: unknown Food Status: UNKNOWN Sources: |
Disc. AE: Death... Other AEs: Respiratory failure, Hemodynamic edema... AEs leading to discontinuation/dose reduction: Death (4.5%) Other AEs:Respiratory failure (14.0%) Sources: Hemodynamic edema (4.6%) |
AEs
| AE | Significance | Dose | Population |
|---|---|---|---|
| Death | 17.4% Disc. AE |
3 mg 4 times / day steady, intravenous Highest studied dose Dose: 3 mg, 4 times / day Route: intravenous Route: steady Dose: 3 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: unknown Food Status: UNKNOWN Sources: |
| Abdominal pain | 1.0% | 1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: M+F Food Status: UNKNOWN Sources: |
| Haemodynamic edema, effusions and fluid overload | 2.0% | 1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: M+F Food Status: UNKNOWN Sources: |
| Hepatic disorders | 33.3% | 1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: M+F Food Status: UNKNOWN Sources: |
| Gastrointestinal hemorrhage | 4.0% | 1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: M+F Food Status: UNKNOWN Sources: |
| Respiratory failure | 5.1% | 1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: M+F Food Status: UNKNOWN Sources: |
| Death | 50.8% Disc. AE |
1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: M+F Food Status: UNKNOWN Sources: |
| Respiratory failure | 14.0% | 1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: unknown Food Status: UNKNOWN Sources: |
| Death | 4.5% Disc. AE |
1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: unknown Food Status: UNKNOWN Sources: |
| Hemodynamic edema | 4.6% | 1 mg 4 times / day steady, intravenous Studied dose Dose: 1 mg, 4 times / day Route: intravenous Route: steady Dose: 1 mg, 4 times / day Sources: |
unhealthy, ADULT Health Status: unhealthy Age Group: ADULT Sex: unknown Food Status: UNKNOWN Sources: |
Overview
| CYP3A4 | CYP2C9 | CYP2D6 | hERG |
|---|---|---|---|
OverviewOther
Drug as perpetrator
Drug as victim
PubMed
| Title | Date | PubMed |
|---|---|---|
| [Refractory hypotension during anesthesia in a patient treated with angiotensin receptor blockers]. | 2004-08-12 |
|
| Effects of terlipressin on systolic pulmonary artery pressure of patients with liver cirrhosis: an echocardiographic assessment. | 2004-08-01 |
|
| Role of vasopressin in the management of septic shock. | 2004-07 |
|
| Pressure or flow? | 2004-06 |
|
| Clinical review: influence of vasoactive and other therapies on intestinal and hepatic circulations in patients with septic shock. | 2004-06 |
|
| Terlipressin for cerebral perfusion pressure support in a patient with septic shock. | 2004-06 |
|
| Effect of terlipressin on blood volume distribution in patients with cirrhosis. | 2004-05 |
|
| A prospective double blind randomized study comparing the need for blood transfusion with terlipressin or a placebo during early excision and grafting of burns. | 2004-05 |
|
| Terlipressin in patients with septic shock: friend or foe? | 2004-05 |
|
| [Acute upper gastrointestinal variceal bleeding: vasoactive agents]. | 2004-04 |
|
| Effects of terlipressin on systemic and regional haemodynamics in catecholamine-treated hyperkinetic septic shock. | 2004-04 |
|
| A long-acting vasopressin analog for septic shock: brilliant idea or dangerous folly? | 2004-03 |
|
| Terlipressin as rescue therapy for intractable hypotension during neonatal septic shock. | 2004-03 |
|
| Terlipressin bolus induces systemic vasoconstriction in septic shock. | 2004-03 |
|
| Terlipressin for catecholamine-resistant septic shock in children. | 2004-03 |
|
| Terlipressin and gelafundin: safe therapy of hepatorenal syndrome. | 2004-02-27 |
|
| Somatostatin, somatostatin analogues and other vasoactive drugs in the treatment of bleeding oesophageal varices. | 2004-02 |
|
| Medical management of variceal bleeding in patients with cirrhosis. | 2004-02 |
|
| Science Review: Vasopressin and the cardiovascular system part 2 - clinical physiology. | 2004-02 |
|
| Worsening of cerebral hyperemia by the administration of terlipressin in acute liver failure with severe encephalopathy. | 2004-02 |
|
| Systemic, portal and renal effects of terlipressin in patients with cirrhotic ascites: pilot study. | 2004-01 |
|
| Effects of treatment of hepatorenal syndrome before transplantation on posttransplantation outcome. A case-control study. | 2004-01 |
|
| [Vasopressin and its analogues in the therapy of shock]. | 2004 |
|
| Vasopressors for shock. | 2004 |
|
| Terlipressin and albumin combination treatment in hepatorenal syndrome. | 2003-12 |
|
| Portal hypertensive bleeding. | 2003-12 |
|
| Effects of the V1a vasopressin agonist F-180 on portal hypertension-related bleeding in portal hypertensive rats. | 2003-12 |
|
| Terlipressin infusion in catecholamine-resistant shock. | 2003-10 |
|
| [Vasoconstrictive Therapies for Bleeding Esophageal Varices and their Mechanisms of Action]. | 2003-10 |
|
| Review article: the management of acute variceal bleeding. | 2003-08-01 |
|
| Terlipressin plus hydroxyethyl starch infusion: an effective treatment for hepatorenal syndrome. | 2003-08 |
|
| [Vasodilatory septic shock refractory to catecholamines: is there a role for terlipressin?]. | 2003-07 |
|
| Is spontaneous bacterial peritonitis an inducer of vasopressin analogue side-effects? A case report. | 2003-07 |
|
| When endoscopic therapy or pharmacotherapy fails to control variceal bleeding: what should be done? Immediate control of bleeding by TIPS? | 2003-07 |
|
| Cyclooxygenase expression in splanchnic hyposensitivity to glypressin of bleeding portal hypertensive rats. | 2003-06 |
|
| Terlipressin versus norepinephrine to correct refractory arterial hypotension after general anesthesia in patients chronically treated with renin-angiotensin system inhibitors. | 2003-06 |
|
| [Acute upper gastrointestinal hemorrhage. Diagnosis and management]. | 2003-05 |
|
| Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis: a Cochrane meta-analysis. | 2003-05 |
|
| Comment on "Terlipressin in chronic hyperdynamic endotoxic shock: is it safe?" by P. Asfar. | 2003-05 |
|
| [Drug therapy of portal hypertension]. | 2003-04 |
|
| Terlipressin and albumin for the hepatorenal syndrome. | 2003-04 |
|
| Comparison of Doppler ultrasonography and the hepatic venous pressure gradient in assessing portal hypertension in liver cirrhosis. | 2003-04 |
|
| Terlipressin in chronic hyperdynamic endotoxic shock: is it safe? | 2003-02 |
|
| Terlipressin dose response in healthy and endotoxemic sheep: impact on cardiopulmonary performance and global oxygen transport. | 2003-02 |
|
| Hepatorenal syndrome. | 2003-01-02 |
|
| [Hepatorenal syndrome: from physiopathology to treatment]. | 2003-01 |
|
| Patient with a sudden drop in blood pressure. | 2003-01 |
|
| Low-dose terlipressin improves systemic and splanchnic hemodynamics in fluid-challenged endotoxic rats. | 2003-01 |
|
| Management of acute variceal bleeding. | 2003 |
|
| Update on treatment of variceal hemorrhage. | 2002 |
Sample Use Guides
Recommended Dosage Regimen: (2.2) • Days 1 to 3 administer TERLIVAZ 0.85 mg (1 vial) intravenously every 6 hours. • Day 4: Assess serum creatinine (SCr) versus baseline. • If SCr has decreased by at least 30% from baseline, continue TERLIVAZ 0.85 mg (1 vial) intravenously every 6 hours. • If SCr has decreased by less than 30% from baseline, dose may be increased to TERLIVAZ 1.7 mg (2 vials) intravenously every 6 hours.
Route of Administration:
Intravenous
In Vitro Use Guide
Sources: https://pubmed.ncbi.nlm.nih.gov/27586252
Terlipressin also non-selectively interacted with all the vasopressin receptors but with an affinity reduced by at least 710 folds (Ki in nM: 852 for hV1A-R; 1115 for hV1B-R; and 1580 for hV2-R)
| Substance Class |
Protein
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| Protein Sub Type | |
| Sequence Type | COMPLETE |
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4U092XZF0K
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| Record Status |
FAILED
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| Record Version |
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C80212
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PARENT -> SALT/SOLVATE |
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ANHYDROUS->SOLVATE |
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ACTIVE MOIETY |
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Structural Modifications
| Modification Type | Location Site | Location Type | Residue Modified | Extent | Fragment Name | Fragment Approval |
|---|---|---|---|---|---|---|
| MOIETY |
Amount:
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WATER | 059QF0KO0R | |||
| MOIETY |
Amount:
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Acetic acid | Q40Q9N063P | |||
| AMINO ACID SUBSTITUTION | [1_12] | GLYCINE | GLYCINAMIDE | 4JDT453NWO |
| Name | Property Type | Amount | Referenced Substance | Defining | Parameters | References |
|---|---|---|---|---|---|---|
| Molecular Formula | CHEMICAL |
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| MOL_WEIGHT:SEQUENCE(CALCULATED) | CHEMICAL |
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