Terlipressin

TERLIVAZ

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Pronunciation: ter-li-PRES-in

Terlipressin ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Terlipressin ballicule

What it isV1- and V2-receptor agonist producing splanchnic vasoconstriction; hepatorenal syndrome.

Why this oneIt is the first targeted vasoconstrictor approved to reverse hepatorenal syndrome with rapid kidney decline.

What limits itSerious or fatal respiratory failure and ischemia require oxygenation screening; avoid in hypoxia and monitor sodium.

Terlipressin molecular structure (skeletal formula) — Molecular structure: Terlipressin

FDA-approved for

hepatorenal syndrome (2022)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Serious or fatal respiratory failure; risk increased with volume overload or ACLF Grade 3 — assess SpO2 before start, do not initiate if hypoxic, monitor continuous pulse oximetry and discontinue if SpO2 <90%.

FDA dosing	Population	Start	Target	Max
Hepatorenal syndrome with rapid reduction in kidney function	Adults	0.85 mg (1 vial) IV q6h (Days 1–3)	0.85 mg q6h; may increase to 1.7 mg (2 vials) q6h on Day 4 if SCr decreased <30% from baseline	1.7 mg (2 vials) IV q6h

Renal Undefined

Hepatic No adjustment needed

Day 4: adjust dose by change in SCr from baseline; discontinue if SCr at/above baseline; continue until 24h after two consecutive SCr ≤1.5 mg/dL, max 14 days

Instructions

Reconstitute each vial with 5 mL 0.9% Sodium Chloride (0.85 mg/5 mL)
Give by slow IV bolus over 2 minutes via peripheral or central line; flush line after
Obtain baseline SpO2 and assess ACLF grade/volume status before first dose; monitor continuous pulse oximetry
Do not initiate in hypoxic patients (e.g., SpO2 <90%) until oxygenation improves; avoid in ACLF Grade 3

Available strengths

inj 0.85 mg

Contraindications

Hypoxia or worsening respiratory symptoms
Ongoing coronary, peripheral, or mesenteric ischemia

Cautions

Serious or fatal respiratory failure — manage volume overload
Adverse reactions may make patient ineligible for liver transplant (esp. MELD ≥35)
Vasoconstrictor — cardiac, cerebrovascular, peripheral, or mesenteric ischemia
Embryo-fetal toxicity — induces uterine contractions and endometrial ischemia

Adverse reactions

Abdominal pain
Nausea
Respiratory failure
Diarrhea
Dyspnea
Fluid overload

Pregnancy May cause fetal harm; induces uterine contractions and endometrial ischemia

Lactation No data on presence in milk; weigh clinical need against risk

Cost

Terlipressin (TERLIVAZ)

Strength		#/mo	generic $/unit	CostPlus
0.85 mg	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Terlipressin is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

⚠ BOXED WARNING

Serious or fatal respiratory failure

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryN/A (post-2015 labeling)

Defining liabilityRespiratory failure and ischemic complications

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