Quick answer: what is Terlipressin?
Terlipressin is a long-acting vasopressin analog used in advanced liver disease, acting as a slow-release prodrug of lysine-vasopressin.
Quick facts
- Class
- Vasopressin analog (prodrug of lysine-vasopressin)
- Brand names
- Terlivaz, Glypressin
- Approved / used for
- Hepatorenal syndrome; variceal bleeding
- Administration
- Intravenous, in hospital
- Status
- FDA-approved (hepatorenal syndrome); prescription-only
- Targets
- Vasopressin V1 receptor (splanchnic vessels)
- Key trial
- CONFIRM (hepatorenal syndrome)
- Setting
- Intravenous, hospital only
Key takeaways
- It constricts the dilated splanchnic blood vessels of cirrhosis, improving kidney blood flow and lowering portal pressure.
- It is FDA-approved for hepatorenal syndrome (based on the CONFIRM trial) and widely used for bleeding esophageal varices.
- Because it constricts vessels broadly, its main risks are ischemia and fluid overload; it is given in hospital.
Overview
Terlipressin is a long-acting synthetic analog of vasopressin, acting as a slow-release prodrug that is gradually converted to active lysine-vasopressin in the body. This gives a steadier effect than natural vasopressin and suits it to the specific circulatory problems of advanced liver disease.[1]
It is a specialist hospital medicine, most associated with two serious complications of cirrhosis: hepatorenal syndrome and variceal bleeding.[2][3]
How it works
Terlipressin preferentially activates V1 receptors on blood vessels in the splanchnic circulation — the vessels supplying the gut. In cirrhosis these vessels are abnormally dilated, which lowers effective blood flow to the kidneys and raises pressure in the portal vein. By constricting them, terlipressin redirects blood to the systemic circulation, improving kidney perfusion and reducing portal pressure.[1][2]
Clinical uses & evidence
Hepatorenal syndrome
In the randomized CONFIRM trial, terlipressin plus albumin improved the reversal of type 1 hepatorenal syndrome — a rapidly progressive kidney failure in advanced liver disease — supporting its FDA approval for this use.[2]
Variceal bleeding
By lowering portal pressure, terlipressin helps control acute bleeding from esophageal varices and is a standard part of management in many countries.[3][4]
Forms & how it's given
Terlipressin is given intravenously in a hospital, either as intermittent injections or a continuous infusion, always under close monitoring and typically alongside albumin for hepatorenal syndrome. It is not a self-administered medicine and has no consumer dosing.
Safety & legal status
Because it constricts blood vessels, terlipressin carries risks of ischemia (reduced blood flow to the heart, gut, skin, or limbs) and can cause fluid overload and respiratory complications, which is why patient selection and monitoring matter. It is an FDA-approved, prescription-only hospital medicine, not an unregulated compound.
Frequently asked questions
What is terlipressin used for?
Terlipressin is used in advanced liver disease: it is FDA-approved for hepatorenal syndrome — a rapid kidney failure in cirrhosis — and is widely used to control acute bleeding from esophageal varices by lowering pressure in the portal vein.
How does terlipressin work?
It is a slow-release prodrug converted to lysine-vasopressin, which constricts the abnormally dilated splanchnic (gut) blood vessels seen in cirrhosis. This redirects blood to the general circulation, improving kidney perfusion and reducing portal pressure.
What did the CONFIRM trial show?
The CONFIRM trial found that terlipressin plus albumin improved the reversal of type 1 hepatorenal syndrome compared with placebo, supporting its FDA approval for this use, though clinicians weigh its benefits against risks such as respiratory complications.
What are the risks of terlipressin?
Because it constricts blood vessels, terlipressin can reduce blood flow to the heart, gut, skin, and limbs (ischemia), and can cause fluid overload and respiratory problems. Careful patient selection and monitoring are essential; it is a hospital-administered medicine.
References
Each source links to its original record — peer-reviewed studies, regulator pages, or reference texts, labelled by type. We summarize findings neutrally; a citation is a reference, not an endorsement, and not a claim that its authors reviewed this page.
- Wong F. Terlipressin for hepatorenal syndrome. Curr Opin Gastroenterol. 2024. Peer-reviewed study
- Wong F, Pappas SC, Curry MP, et al. Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome. N Engl J Med. 2021. Peer-reviewed study
- Tapper EB, Parikh ND. Diagnosis and Management of Cirrhosis and Its Complications: A Review. JAMA. 2023. Peer-reviewed study
- Singh S, Chandan S, Vinayek R, et al. Comprehensive approach to esophageal variceal bleeding: From prevention to treatment. World J Gastroenterol. 2024. Peer-reviewed study