U.S. Department of Health & Human Services Divider Arrow National Institutes of Health Divider Arrow NCATS
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

Targets

Primary TargetPharmacologyConditionPotency
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

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
TERLIVAZ

Approved Use

TERLIVAZ is a vasopressin receptor agonist indicated to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function.

Launch Date

2022
Primary
GLYPRESSIN

Approved Use

GLYPRESSIN 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

Cmax

ValueDoseCo-administeredAnalytePopulation
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

AUC

ValueDoseCo-administeredAnalytePopulation
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

T1/2

ValueDoseCo-administeredAnalytePopulation
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

Doses

DosePopulationAdverse 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%)
Respiratory failure (5.1%)
Gastrointestinal hemorrhage (4.0%)
Abdominal pain (1.0%)
Haemodynamic edema, effusions and fluid overload (2.0%)
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: 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%)
Hemodynamic edema (4.6%)
Sources:
AEs

AEs

AESignificanceDosePopulation
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:
OverviewDrug as perpetrator​

Drug as perpetrator​

TargetModalityActivityMetaboliteClinical evidence
no [IC50 >=5000 uM]
no [IC50 >=5000 uM]
no [IC50 >=5000 uM]
no [IC50 >=5000 uM]
no [IC50 >=5000 uM]
no [IC50 >=5000 uM]
no [IC50 >=5000 uM]
no [IC50 >=5000 uM]
no [IC50 >=5000 uM]
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
no
Drug as victim
PubMed

PubMed

TitleDatePubMed
[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
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
Created
by admin
on Mon Mar 31 20:36:51 GMT 2025
Edited
by admin
on Mon Mar 31 20:36:51 GMT 2025
Protein Sub Type
Sequence Type COMPLETE
Record UNII
4U092XZF0K
Record Status FAILED
Record Version
  • Download
Name Type Language
TERLIPRESSIN DIACETATE PENTAHYDRATE
Preferred Name English
TERLIPRESSIN ACETATE
MART.   WHO-DD  
Common Name English
TERLIPRESSIN ACETATE [JAN]
Common Name English
TERLIVAZ
Brand Name English
TERLIPRESSIN ACETATE [MART.]
Common Name English
Terlipressin acetate [WHO-DD]
Common Name English
Classification Tree Code System Code
NCI_THESAURUS C80212
Created by admin on Mon Mar 31 20:36:51 GMT 2025 , Edited by admin on Mon Mar 31 20:36:51 GMT 2025
Code System Code Type Description
SMS_ID
300000045090
Created by admin on Mon Mar 31 20:36:51 GMT 2025 , Edited by admin on Mon Mar 31 20:36:51 GMT 2025
PRIMARY
DRUG BANK
DBSALT002332
Created by admin on Mon Mar 31 20:36:51 GMT 2025 , Edited by admin on Mon Mar 31 20:36:51 GMT 2025
PRIMARY
EVMPD
SUB04727MIG
Created by admin on Mon Mar 31 20:36:51 GMT 2025 , Edited by admin on Mon Mar 31 20:36:51 GMT 2025
PRIMARY
PUBCHEM
139032838
Created by admin on Mon Mar 31 20:36:51 GMT 2025 , Edited by admin on Mon Mar 31 20:36:51 GMT 2025
PRIMARY
FDA UNII
4U092XZF0K
Created by admin on Mon Mar 31 20:36:51 GMT 2025 , Edited by admin on Mon Mar 31 20:36:51 GMT 2025
PRIMARY
NCI_THESAURUS
C99153
Created by admin on Mon Mar 31 20:36:51 GMT 2025 , Edited by admin on Mon Mar 31 20:36:51 GMT 2025
PRIMARY
Related Record Type Details
PARENT -> SALT/SOLVATE
ANHYDROUS->SOLVATE
Related Record Type Details
ACTIVE MOIETY

Structural Modifications

Modification Type Location Site Location Type Residue Modified Extent Fragment Name Fragment Approval
MOIETY Amount: WATER 059QF0KO0R
MOIETY Amount: Acetic acid Q40Q9N063P
AMINO ACID SUBSTITUTION [1_12] GLYCINE GLYCINAMIDE 4JDT453NWO
Name Property Type Amount Referenced Substance Defining Parameters References
Molecular Formula CHEMICAL
MOL_WEIGHT:SEQUENCE(CALCULATED) CHEMICAL