At a glance
| Product | Terlivaz |
|---|---|
| Route | Intravenous |
| U.S. use | HRS with rapid kidney-function decline |
| Boxed warning | Serious or fatal respiratory failure |
| Care setting | Hospital specialist monitoring |
Overview
Hepatorenal syndrome can develop in advanced liver disease when severe circulatory changes impair kidney perfusion. Terlivaz is used for the form with rapid reduction in kidney function, alongside careful management of volume status and the underlying liver disease. It does not repair the liver or establish that transplantation is unnecessary. Benefits are less likely in very advanced renal dysfunction, and treatment-related complications can affect transplant eligibility. Uses in other countries, including some portal-hypertension settings, should be distinguished from the specific U.S. approval and the patient's immediate clinical circumstances.
How it works
Terlipressin acts at vasopressin receptors and is converted to lysine vasopressin. Vasoconstriction, particularly in the splanchnic circulation, can improve effective circulating volume and renal perfusion in hepatorenal syndrome. The same constrictive effect can compromise coronary, mesenteric or peripheral blood supply. Its actions therefore demand assessment of both the potential kidney response and cardiopulmonary or ischemic vulnerability.
The approved indication
The U.S. label covers adults with hepatorenal syndrome and rapidly declining kidney function. Patients with serum creatinine above 5 mg/dL are unlikely to benefit, underscoring that severity and timing influence the treatment decision.
Supporting sources [1]
Benefit and harm in CONFIRM
CONFIRM found verified reversal of hepatorenal syndrome in 32% with terlipressin versus 17% with placebo, with albumin strongly recommended in both groups. Respiratory complications were more frequent. Improved renal response did not establish a survival advantage.
Supporting sources [2]
Respiratory failure warning
Volume overload and grade 3 acute-on-chronic liver failure increase respiratory risk. The label requires oxygenation assessment and ongoing monitoring. Existing hypoxia or worsening respiratory symptoms are contraindications.
Supporting sources [1]
Ischemia and transplant planning
Ongoing coronary, peripheral or mesenteric ischemia is a contraindication. Vasoconstriction can produce new ischemic events. A serious adverse reaction may make a listed patient temporarily or permanently ineligible for liver transplantation, so renal response is not the only relevant endpoint.
Supporting sources [1]
What improvement does not mean
A falling creatinine can show a useful hemodynamic response while advanced liver disease remains. Clinical care continues to address infection, volume status, respiratory function and transplant candidacy rather than viewing one improved laboratory value as definitive recovery.
Reading this profile
Jurisdiction: United States — FDA-approved prescription medicine; indication and formulation restrictions apply.. Molecular class: Vasopressin analog peptide and vasoconstrictor.
This profile was written with AI-assisted research and checked against the linked sources. It has not been represented as a clinician’s review. Evidence summaries describe the cited studies and products; they do not establish that a separately purchased preparation is equivalent.
Sources & references
Follow the original material. Product labels define specific formulations and uses; trial registration describes a study and does not by itself establish benefit.
- FDA: Terlivaz prescribing information ↗Regulatory source · Checked 2026-10-27
- Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome. ↗Original research · Checked 2026-10-27