Bone & endocrine
Terlipressin
A slow-release vasopressin analogue licensed for hepatorenal syndrome and bleeding oesophageal varices.
What it is
Terlipressin is a synthetic vasopressin analogue carrying three glycine residues that are slowly cleaved in the body, releasing active lysine-vasopressin over hours. The result is a long-acting V1 effect on blood vessels - constricting the splanchnic circulation - rather than the kidney. It is licensed in the EU (Glypressin) and, since 2022, in the US (Terlivaz).
How it works
- 1
Stimulates V1 receptors on vascular smooth muscle, constricting the splanchnic arterial bed.
- 2
Lowering splanchnic inflow reduces portal pressure, which is why it is used in variceal bleeding.
- 3
Improves effective arterial blood volume, which restores renal perfusion in hepatorenal syndrome.
- 4
The glycine residues act as a slow-release depot, so one dose lasts hours.
- 5
Has little V2 activity, so it does not concentrate urine the way desmopressin does.
What it's studied for
Reported and studied effects
- Reversal of hepatorenal syndrome in roughly a third to a half of patients when combined with albumin in trials
- Reduced portal pressure and better control of variceal bleeding
- Improved renal function markers over days
- Ischaemic complications, including skin and bowel ischaemia
Research protocol notes
Research context onlyResearch context only - a hospital medicine. In hepatorenal syndrome trials terlipressin was given as 0.85 to 1 mg intravenously every four to six hours, escalated when needed toward a maximum of about 12 mg per day, alongside albumin, for up to 14 days; variceal bleeding regimens typically use 1 to 2 mg every four to six hours for two to five days with close monitoring for ischaemia.
These figures are described so you can understand what researchers did. They are not a dose, a schedule, or a suggestion — and they are not a substitute for a doctor.
Possible side effects and contraindications
Safety profile
Possible side effects
- Abdominal pain and ischaemic skin necrosis
- Peripheral or gut ischaemia
- Hyponatraemia
- Fluid overload and pulmonary oedema
- Bradycardia
- Respiratory failure was reported more often than placebo in the CONFIRM trial
Contraindications and cautions
- History of ischaemic heart disease or peripheral vascular disease
- Hyponatraemia or fluid overload
- Uncontrolled hypertension
- Prior hypersensitivity
- Only for use where ischaemic complications can be monitored
A side-effect list is never complete, and these are not the only situations that warrant caution. Anything unexpected, or anything you are unsure about, should be discussed with a doctor before use.
Evidence assessment
Randomised trials in hepatorenal syndrome (OT-0401 and CONFIRM) are modest in size, show real benefit but also meaningful adverse events, and are supported by long use in variceal bleeding.
References
- 01Wong et al., Terlipressin plus albumin for hepatorenal syndrome (CONFIRM), NEJM 2021
- 02European Medicines Agency - Glypressin product information
References link to published literature, regulator pages or literature indexes. Where a link points to a search, it collects the peer-reviewed work on that molecule rather than a single study.
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Desmopressin
A long-acting vasopressin analogue approved for central diabetes insipidus, bedwetting and mild bleeding disorders.
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