Terlipressin (Terlivaz)_Dosage, benefits & legal status
Also known as Terlivaz, Glypressin, Glypressine, Variquel, Lucassin, terlipressin acetate, triglycyl-lysine vasopressin
A hospital-only vasopressin analogue for hepatorenal syndrome, with a boxed warning for fatal respiratory failure.
Common vial size is what vendors typically sell, not a recommendation. Enter your own vial in the calculator.
What is Terlipressin (Terlivaz)?
Plain language first. The technical label stays, but it never stands alone.Overview
It narrows blood vessels, raising blood pressure and lowering pressure in the liver's portal circulation, so more blood reaches the kidneys. In its approval trial it reversed the kidney failure in 29% of patients against 16% on placebo, at the cost of more respiratory failure.
Terlipressin is a 12-residue prodrug of lysine-vasopressin: tissue enzymes clip three glycines off its front end to release the active hormone. Ferring has sold it in Europe since the 1980s for bleeding oesophageal varices. In the US it was approved in September 2022 as Terlivaz, after two rejections, for hepatorenal syndrome.
What it's used for
A hospital IV drug to improve kidney function in adults with hepatorenal syndrome, a kidney failure caused by advanced liver disease. It can cause serious or fatal respiratory failure.
How does Terlipressin (Terlivaz) work?
What it does in the body, and where.Terlipressin is lysine-vasopressin with three extra glycines on the front. Tissue enzymes trim them off to release the active hormone.
- 01V1 over V2It has about twice the selectivity for V1 receptors, on blood vessel muscle, as for V2 receptors, the ones desmopressin targets to make the kidneys hold water.
- 02Prodrug and drugIt releases lysine-vasopressin and also has activity of its own. Blood pressure rose and heart rate fell within 5 minutes of a dose and stayed changed for at least 6 hours.
- 03Why the kidneys benefitThe label's explanation: lower portal pressure and less blood in the portal vessels, plus higher effective arterial volume and blood pressure, increase blood flow to the kidneys.
A schematic of the compound's mechanism, not a diagnostic image.
What else is it used for?
Each group carries its own evidence level.Approved means regulators have cleared it for that purpose. Investigational means it is in trials. Early research means it is being studied and is not established.
CONFIRM, the approval trial
FDA-approved- Human trial300 adults with hepatorenal syndrome, all on albumin: verified reversal 29.1% against 15.8%, durable reversal 31.7% against 15.8%, and 33.3% against 6.3% in the subgroup with systemic inflammation.
- RegulatorySerious respiratory failure in 14% against 5.1%; 17 of the 28 cases on terlipressin were fatal, against 1 of 5 on placebo.
Earlier US trials
tested-and-failed- Human trialOT-0401, 112 patients: treatment success 25% against 12.5%, not significant (p=0.093), though reversal alone was 33.9% against 12.5%.
- Human trialREVERSE, 196 patients: confirmed reversal 19.6% against 13.1%, not significant, with more ischaemic events on terlipressin.
Against other vasoconstrictors
Clinical use- Human trialAgainst midodrine plus octreotide, 48 patients: kidney function restored in 70.4% against 28.6%.
- Human trialAgainst noradrenaline in acute-on-chronic liver failure, 120 patients, open label: reversal 40% against 16.7%, with more side-effect discontinuations on terlipressin (23.3% against 8.3%).
It is often confused with desmopressin, a V2 receptor drug that makes the kidneys hold water; terlipressin favours V1 and narrows blood vessels. It is not the same as vasopressin: 12 residues instead of 9, lysine instead of arginine at position 8, and a three-glycine extension that makes it a prodrug. US doses are written as terlipressin base and European ones as the acetate salt, a 15% difference. The CONFIRM result reads 29.1% against 15.8% in the label and 32% against 17% in the NEJM paper, so cite the source you use. The 14% against 5% figure counts serious or fatal respiratory failure; any respiratory failure was 15.5% against 7.1%. It is not new: Europe has used it since the 1980s, and Lucassin was never a US brand.
The published record
Papers and trials about Terlipressin (Terlivaz)
416 papers tagged human · 219 not reviews or lab · 86 clinical trial publications
115 registered trials · 6 with posted results
Furthest stage reached: Approved in the US
Counted from Europe PMC indexing, not read by a person; a human tag can land on reviews, commentary or lab papers; clinical trial publications is the narrower count. 487 papers and 100 trials indexed in detail.
At a glance
Four things to know about Terlipressin (Terlivaz)
Evidence
FDA-approved
Category
Sexual and hormonal
Common vial
Varies
Half-life
About 40 to 55 minutes; the released hormone about 3 hours
How much, and do you cycle it?
The range, and whether you take breaks.0.85 to 1.7 mg every 6 hours (label), every 6 hours for up to 14 days. A single hospital course of up to 14 days FDA label
Given every 6 hours until kidney function recovers or for 14 days at most, with a check on day 4 that decides whether to continue, raise the dose or stop.
About 40 to 55 minutes; the released hormone about 3 hoursFDA label
US population PK: terlipressin 0.9 hours and lysine-vasopressin 3.0 hours. The UK label gives about 40 minutes in cirrhosis. Natural arginine vasopressin lasts 10 minutes or less.
Source: Terlivaz prescribing information section 12.3 (population PK in 69 patients); Glypressin UK SmPC
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How do I dose and price it?
Enter your vial and your dose. Pick a mix. We show the draw and the cost.The vial holds a fixed amount of drug. Adding more water does not make more drug, it just spreads it thinner, so you draw a bigger number on the syringe for the same dose.
Choose your mix
Measuring the water1 mL = one full 100-unit syringe.
How do you store it?
Before mixing, and after.Dry powder in the freezer or fridge. Once mixed, fridge, and use within about a month.
Unmixed lyophilized Terlipressin (Terlivaz) keeps for a long time cold. Once you add water the clock starts: most reconstituted vials hold up for roughly 28 to 30 days at fridge temperature. Keep it out of light, and do not freeze it after mixing.
What are the side effects and cautions?
Known cautions and warnings for this compound.Solubility, computed: 25% charged residues, 33% hydrophobic. Water usually sufficient.
A first-pass rule from peptide manufacturers' guidance. It does not account for disulfide bridges, salt form or how the powder was dried, and it predicts what should be easy rather than what will happen in your vial.
Who should avoid it
- Low oxygen levels or worsening breathing symptoms
- Ongoing ischaemia of the heart, limbs or gut
- Serum creatinine above 5 mg/dL: the label says benefit is unlikely
- Fluid overload or acute-on-chronic liver failure grade 3, the groups at highest risk of respiratory failure
- A MELD score of 35 or more, where the label says benefit may not outweigh risk
- Pregnancy: it may cause fetal harm
Stop and get help
- Oxygen saturation below 90% on the pulse oximeter, or new shortness of breath (the label requires continuous monitoring)
- Chest pain, or a cold, pale or painful hand, foot or finger
- Severe stomach pain, a possible sign of gut ischaemia
- Rapid fluid build-up: new swelling or crackly breathing
Common effects
- Abdominal pain in 19.5% against 6.1% on placebo
- Nausea in 16% and diarrhoea in 13%
- Respiratory failure in 15.5% against 7.1%, and shortness of breath in 12.5%
- Fluid overload in 8.5% and a slow heart rate in 5%
- 12% stopped treatment because of side effects, against 5% on placebo
Where this page says nothing is established, that means nobody has studied it, not that a compound is safe.
Is Terlipressin (Terlivaz) approved?
And where the numbers on this page come from.Yes. Terlipressin (Terlivaz) is FDA approved and available on prescription in the United States. It is approved in United Kingdom, France, and European Union, but not in the United States.
- Approval statusFDA-approved
- RouteInto a vein (IV bolus), in hospital
- Checked11 October 2026
- Approved outside the USUnited Kingdom, France, European Union: Sold by Ferring as Glypressin in the UK since October 1983 for bleeding oesophageal varices, and as Glypressine in France since 1987, where it is also indicated for hepatorenal syndrome type 1. Nationally authorised across the EU, where a 2022 review confirmed the hepatorenal indication with new restrictions. Also approved in the US.This does not change the United States position above.
- DoseFrom the drug label. The manufacturer tested this range and a regulator reviewed it.
- Vial sizeFrom what vendors typically list; not a recommendation.
- SourcesTerlivaz prescribing information (revised June 2026)FDA approval letter, NDA 022231 (14 Sep 2022)FDA, Terlivaz other action lettersFDA, Terlivaz risk assessment reviewWong F et al., New England Journal of Medicine 2021;384:818-828 (CONFIRM)ClinicalTrials.gov, CONFIRM (NCT02770716)EMA, terlipressin-containing medicines referralGlypressin UK summary of product characteristicsCavallin M et al., Hepatology 2015;62:567-574
What has happened recently
FDA-approved on 14 September 2022 (NDA 022231) to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function. The US application was rejected in November 2009 and again in September 2020, after an advisory committee voted 8 to 7 in favour. Ferring's Glypressin has been authorised in the UK since October 1983 for bleeding oesophageal varices, and in France since 1987, where the label also covers hepatorenal syndrome type 1. A 2022 EU review added advice to avoid it at creatinine of 5 mg/dL or more and in the sickest patients. The US holder is Mallinckrodt, now part of Keenova.
You can compare this against the whole library, or read how to check a seller.
What else is like Terlipressin (Terlivaz)?
Others in Sexual and hormonal, side by side.If you're weighing Terlipressin (Terlivaz), it's worth reading Toremifene, PT-141 (Bremelanotide), and Kisspeptin in the same class.
A hospital-only vasopressin analogue for hepatorenal syndrome, with a boxed warning for fatal respiratory failure.
- Dose
- 0.85 to 1.7 mg every 6 hours (label)
- How often
- Every 6 hours for up to 14 days
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- How often
- Daily
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- Dose
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- How often
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A peptide that switches on natural sex-hormone signaling for libido and fertility.
- Dose
- 0.1 up to 0.2 mg per dose
- How often
- Daily in vendor protocols
Guides for this compound
- How to Reconstitute a Peptide
Mix peptide powder with bacteriostatic water, step by step.
- How to Read an Insulin Syringe
Read the units, convert to millilitres, and draw the exact dose.
- mcg vs mg: The Peptide Dosing Mistake to Avoid
Your vial says mg and your protocol says mcg. Here is the conversion and how to check it.
Sources
- Terlivaz prescribing information (revised June 2026)(2026)Boxed warning for serious or fatal respiratory failure. CONFIRM: verified HRS reversal 29.1% against 15.8% (p=0.012). Half-life 0.9 hours (terlipressin) and 3.0 hours (lysine-vasopressin). Respiratory failure 14% against 5%.
- FDA approval letter, NDA 022231 (14 Sep 2022)(2022)Approved to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function.
- FDA, Terlivaz other action letters(2022)Complete response letters of 4 November 2009 (trial failures, insufficient safety data) and 11 September 2020 (risks may outweigh benefits).
- FDA, Terlivaz risk assessment review(2022)Advisory committee voted 8 to 7 for approval on 15 July 2020. 90-day mortality 51% against 44%; respiratory failure serious events 14% against 5.1%, fatal in 17 of 28 against 1 of 5. No REMS required.
- Wong F et al., New England Journal of Medicine 2021;384:818-828 (CONFIRM)(2021)300 patients: verified HRS reversal 32% against 17%; deaths from respiratory disorders within 90 days 11% against 2%.
- ClinicalTrials.gov, CONFIRM (NCT02770716)(2019)Randomised 2:1, double-blind, placebo-controlled, 300 enrolled from July 2016 to July 2019.
- EMA, terlipressin-containing medicines referral(2022)Nationally authorised products: avoid at creatinine of 442 micromol/L (5.0 mg/dL) or more, or in ACLF grade 3 or MELD 39 or more; continuous infusion may be considered. Sepsis 7% against none on placebo.
- Glypressin UK summary of product characteristics(2026)Ferring, authorised October 1983, for bleeding oesophageal varices. Terminal half-life about 40 minutes in cirrhosis.
- Cavallin M et al., Hepatology 2015;62:567-574(2015)Terlipressin plus albumin restored kidney function in 70.4% against 28.6% on midodrine and octreotide plus albumin.
Beyond these, 587 records are indexed. Browse the records