Terlipressin

Also known as: Terlivaz, Glypressin, Triglycyl-lysine vasopressin

A vasopressin analog FDA-approved as Terlivaz (2022) to improve kidney function in hepatorenal syndrome. Hospital IV medication with a boxed warning.

Last updated October 26, 2026

Mechanism of Action

Terlipressin is a prodrug: three glycine residues on lysine-vasopressin are cleaved in the body to release the active hormone gradually. It is more selective for V1 than V2 receptors and constricts the splanchnic (gut) blood vessels, which shifts blood volume back into the systemic circulation, raises blood pressure and improves blood flow to the kidneys in patients with cirrhosis and hepatorenal syndrome. Outside the US it is also used for variceal bleeding.

Half-life: ~1 hour (terlipressin); ~3 hours (active lysine-vasopressin)
Administration Routes: Intravenous
Research Status: Clinical

Reported Benefits

Improves kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function
Higher HRS reversal rates than placebo when given with albumin (CONFIRM)
Used outside the US for acute variceal bleeding

Potential Side Effects

Boxed warning: serious or fatal respiratory failure, especially with fluid overload or severe acute-on-chronic liver failure
Abdominal pain, nausea, diarrhea
Ischemic events (cardiac, mesenteric, peripheral)
Bradycardia

Common Dosing

Given in hospital as intravenous bolus injections every 6 hours, usually with albumin, after checking oxygen saturation; the dose is adjusted after a few days based on serum creatinine and stopped if there is no response. Treatment is directed by the hospital care team.

The dosing information above is aggregated from research literature and anecdotal community reports for educational purposes only. It is not a recommendation, prescription, or medical advice. Peptides are sold as research chemicals only and are not intended for human use.

Contraindications

Hypoxia (SpO2 below 90%) or worsening respiratory symptoms
Ongoing coronary, peripheral or mesenteric ischemia
Limited benefit expected with serum creatinine of 5 mg/dL or higher

No documented stacking partners for Terlipressin yet.

Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome
2021
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A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome
2008
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Terlipressin use and respiratory failure in patients with hepatorenal syndrome type 1 and severe acute-on-chronic liver failure
2022
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Yes. Terlivaz was FDA-approved in September 2022 for adults with hepatorenal syndrome with rapid reduction in kidney function, after many years of use in Europe and elsewhere. It carries a boxed warning for serious or fatal respiratory failure.

In the CONFIRM trial, respiratory failure was more common with terlipressin than placebo, mainly in patients with fluid overload or severe liver failure. Clinicians check oxygen levels before each dose and manage fluids carefully.