Terlipressin

Terlipressin
Clinical data
Trade names	Terlivaz
AHFS/Drugs.com	International Drug Names
Routes of; administration	Intravenous
ATC code	H01BA04 (WHO) ;
Legal status
Legal status	US: WARNINGRx-only;
Pharmacokinetic data
Protein binding	~30%
Identifiers
	IUPAC name 1-{[(4R,7S,10S,13S,16S,19R)-19-{[({[(aminoacetyl)amino]acetyl}amino)acetyl]amino}-7-(2-amino-2-oxoethyl)-10-(3-amino-3-oxopropyl)-13-benzyl-16-(4-hydroxybenzyl)-6,9,12,15,18-pentaoxo-1,2-dithia-5,8,11,14,17-pentaazacycloicosan-4-yl]carbonyl}-L-prolyl-N-(2-amino-2-oxoethyl)-L-lysinamide;
CAS Number	14636-12-5 ;
PubChem CID	72081;
DrugBank	DB02638 ;
ChemSpider	65067 ;
UNII	7Z5X49W53P;
KEGG	D06672 ;
CompTox Dashboard (EPA)	DTXSID7048952 ;
ECHA InfoCard	100.035.149
Chemical and physical data
Formula	C52H74N16O15S2
Molar mass	1227.38 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES O=C(N)CNC(=O)[C@@H](NC(=O)[C@H]4N(C(=O)[C@H]1NC(=O)[C@@H](NC(=O)[C@@H](NC(=O)[C@@H](NC(=O)[C@@H](NC(=O)[C@@H](NC(=O)CNC(=O)CNC(=O)CN)CSSC1)Cc2ccc(O)cc2)Cc3ccccc3)CCC(=O)N)CC(=O)N)CCC4)CCCCN;
	InChI InChI=1S/C52H74N16O15S2/c53-17-5-4-9-31(45(76)60-23-41(57)72)63-51(82)38-10-6-18-68(38)52(83)37-27-85-84-26-36(61-44(75)25-59-43(74)24-58-42(73)22-54)50(81)65-34(20-29-11-13-30(69)14-12-29)48(79)64-33(19-28-7-2-1-3-8-28)47(78)62-32(15-16-39(55)70)46(77)66-35(21-40(56)71)49(80)67-37/h1-3,7-8,11-14,31-38,69H,4-6,9-10,15-27,53-54H2,(H2,55,70)(H2,56,71)(H2,57,72)(H,58,73)(H,59,74)(H,60,76)(H,61,75)(H,62,78)(H,63,82)(H,64,79)(H,65,81)(H,66,77)(H,67,80)/t31-,32-,33-,34-,35-,36-,37-,38-/m0/s1 ; Key:BENFXAYNYRLAIU-QSVFAHTRSA-N ;
	(verify)

Terlipressin, sold under the brand name Terlivaz among others, is an analogue of vasopressin used as a vasoactive drug in the management of low blood pressure. It has been found to be effective when norepinephrine does not help. Terlipressin is a vasopressin receptor agonist.^[2]

Terlipressin was approved for medical use in the United States in 2022.^[2]^[4]^[5] The US Food and Drug Administration (FDA) considers it to be a first-in-class medication.^[5]^[6]

Medical uses

Terlipressin is indicated to improve kidney function in adults with hepatorenal syndrome with rapid reduction in kidney function.^[2]

Indications for use include norepinephrine-resistant septic shock^[7] although, 2021 Surviving Sepsis Guidelines recommend against its use for adults with septic shock^[8] and hepatorenal syndrome.^[9] In addition, it is used to treat bleeding esophageal varices.^[10]

Contraindications

Terlipressin is contraindicated in people experiencing hypoxia or worsening respiratory symptoms and in people with ongoing coronary, peripheral or mesenteric ischemia.^[2] Terlipressin may cause fetal harm when used during pregnancy.^[2]

Society and culture

Terlipressin is available in United States,^[11] New Zealand,^[12] Australia, the European Union,^[13] India, Pakistan & UAE. It is sold under various brand names including Glypressin and Terlivaz.

References

^ "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 Oct 2023.
^ ^a ^b ^c ^d ^e ^f "Terlivaz- terlipressin injection, powder, lyophilized, for solution". DailyMed. 19 September 2022. Archived from the original on 28 September 2022. Retrieved 27 September 2022.
^ "Drug Approval Package: Terlivaz". U.S. Food and Drug Administration (FDA). 7 October 2022. Retrieved 4 December 2022.
^ "Drug Approval Package: Terlivaz". U.S. Food and Drug Administration (FDA). 7 October 2022. Retrieved 23 January 2023.
^ ^a ^b "Advancing Health Through Innovation: New Drug Therapy Approvals 2022". U.S. Food and Drug Administration (FDA). 10 January 2023. Retrieved 22 January 2023. This article incorporates text from this source, which is in the public domain.
^ New Drug Therapy Approvals 2022 (PDF). U.S. Food and Drug Administration (FDA) (Report). January 2024. Archived from the original on 14 January 2024. Retrieved 14 January 2024. This article incorporates text from this source, which is in the public domain.
^ O'Brien A, Clapp L, Singer M (April 2002). "Terlipressin for norepinephrine-resistant septic shock". Lancet. 359 (9313): 1209–1210. doi:10.1016/S0140-6736(02)08225-9. PMID 11955542. S2CID 38463837.
^ Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. (November 2021). "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021". Critical Care Medicine. 49 (11): e1063 – e1143. doi:10.1097/CCM.0000000000005337. PMID 34605781.
^ Uriz J, Ginès P, Cárdenas A, Sort P, Jiménez W, Salmerón JM, et al. (July 2000). "Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome". Journal of Hepatology. 33 (1): 43–48. doi:10.1016/S0168-8278(00)80158-0. PMID 10905585.
^ Ioannou G, Doust J, Rockey DC (2003). Ioannou GN (ed.). "Terlipressin for acute esophageal variceal hemorrhage". The Cochrane Database of Systematic Reviews (1): CD002147. doi:10.1002/14651858.CD002147. PMC 7017851. PMID 12535432.
^ "FDA approves treatment to improve kidney function in adults with hepatorenal syndrome". FDA. 14 September 2022. Archived from the original on 2023-02-10. Retrieved 2023-02-21.
^ "GLYPRESSIN 1mg/8.5mL Solution for Injection; Terlipressin acetate" (PDF). Medsafe, New Zealand Medicines and Medical Devices Safety Authority. New Zeeland Ministry of Health. Archived from the original (PDF) on 2021-12-20.
^ "Terlipressin". Drugs.com. Archived from the original on 2019-06-26. Retrieved 2018-01-23.

External links

"Terlipressin". Drug Information Portal. U.S. National Library of Medicine.

[FDA-AllBoxedWarnings-1] "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 Oct 2023.

[Terlivaz_FDA_label-2] ^ ^a ^b ^c ^d ^e ^f "Terlivaz- terlipressin injection, powder, lyophilized, for solution". DailyMed. 19 September 2022. Archived from the original on 28 September 2022. Retrieved 27 September 2022.

[3] "Drug Approval Package: Terlivaz". U.S. Food and Drug Administration (FDA). 7 October 2022. Retrieved 4 December 2022.

[4] "Drug Approval Package: Terlivaz". U.S. Food and Drug Administration (FDA). 7 October 2022. Retrieved 23 January 2023.

[New_Drug_Therapy_Approvals_2022-5] "Advancing Health Through Innovation: New Drug Therapy Approvals 2022". U.S. Food and Drug Administration (FDA). 10 January 2023. Retrieved 22 January 2023. This article incorporates text from this source, which is in the public domain.

[6] New Drug Therapy Approvals 2022 (PDF). U.S. Food and Drug Administration (FDA) (Report). January 2024. Archived from the original on 14 January 2024. Retrieved 14 January 2024. This article incorporates text from this source, which is in the public domain.

[OBrien-7] O'Brien A, Clapp L, Singer M (April 2002). "Terlipressin for norepinephrine-resistant septic shock". Lancet. 359 (9313): 1209–1210. doi:10.1016/S0140-6736(02)08225-9. PMID 11955542. S2CID 38463837.

[8] Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. (November 2021). "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021". Critical Care Medicine. 49 (11): e1063 – e1143. doi:10.1097/CCM.0000000000005337. PMID 34605781.

[Uriz-9] Uriz J, Ginès P, Cárdenas A, Sort P, Jiménez W, Salmerón JM, et al. (July 2000). "Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome". Journal of Hepatology. 33 (1): 43–48. doi:10.1016/S0168-8278(00)80158-0. PMID 10905585.

[Ioannou-10] Ioannou G, Doust J, Rockey DC (2003). Ioannou GN (ed.). "Terlipressin for acute esophageal variceal hemorrhage". The Cochrane Database of Systematic Reviews (1): CD002147. doi:10.1002/14651858.CD002147. PMC 7017851. PMID 12535432.

[11] "FDA approves treatment to improve kidney function in adults with hepatorenal syndrome". FDA. 14 September 2022. Archived from the original on 2023-02-10. Retrieved 2023-02-21.

[12] "GLYPRESSIN 1mg/8.5mL Solution for Injection; Terlipressin acetate" (PDF). Medsafe, New Zealand Medicines and Medical Devices Safety Authority. New Zeeland Ministry of Health. Archived from the original (PDF) on 2021-12-20.

[13] "Terlipressin". Drugs.com. Archived from the original on 2019-06-26. Retrieved 2018-01-23.

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