Comparison
Elamipretide vs. Terlipressin
Two peptides side-by-side — identity, evidence base, legal status and known adverse events.
Identity
Category
Research other
Research other
CAS no.
736992-21-5
14636-12-5
Molecular weight
639.8 g/mol
1227.37 g/mol
Half-life
no data
no data
Sequence
D-Arg-Dmt-Lys-Phe-NH2no data
Mechanism of action
Elamipretide
Elamipretide is a cell-permeable tetrapeptide with alternating aromatic and basic residues that selectively concentrates on cardiolipin — a phospholipid found almost exclusively in the inner mitochondrial membrane that is important for cristae curvature and the organisation of the respiratory-chain complexes. By binding cardiolipin, elamipretide is proposed to stabilise cristae architecture, support electron transport and ATP production, and reduce the formation of reactive oxygen species. These mechanistic models derive largely from cell and animal models and biophysical work; the extent to which they explain clinical efficacy in humans is, given the mixed trial results, a matter of ongoing research.
Terlipressin
Terlipressin is slowly converted in the body to lysine-vasopressin by cleavage of the three N-terminal glycyl residues (reservoir effect) and activates V1 receptors. The splanchnic vasoconstriction improves renal perfusion in hepatorenal syndrome.
Evidence base
Highest evidence
Human RCT
Human RCT
Studies
4
1
of which in humans
4
1
Effects recorded
4
2
Open conflicts
1
0
Documented adverse events
1
1
Legal status
Full entries
Frequently asked questions
- What is the difference between Elamipretide and Terlipressin?
- Elamipretide is classified as "Research other", while Terlipressin is classified as "Research other". Elamipretide: Elamipretide (SS-31, MTP-131, formerly Bendavia) is a synthetic, mitochondria-targeting tetrapeptide (sequence D-Arg-Dmt-Lys-Phe-NH2) that binds cardiolipin on the inner mitochondrial membrane and is proposed to stabilise cristae structure and support mitochondrial bioenergetics. It was investigated clinically by Stealth BioTherapeutics across several indications, including primary mitochondrial myopathy, Barth syndrome, heart failure, and dry age-related macular degeneration (geographic atrophy). The trial record is mixed, with several pivotal studies missing their primary endpoints. In September 2025 elamipretide (brand name Forzinity) received accelerated FDA approval in the United States solely for the ultra-rare Barth syndrome; for all other investigated indications it remains investigational and it is not approved as a medicine outside the United States. Terlipressin: Terlipressin is a 12-amino-acid vasopressin analog and prodrug of lysine-vasopressin. As a V1 receptor agonist it is vasoconstrictive and is approved for hepatorenal syndrome (FDA 2022, Terlivaz). This page contrasts both neutrally and source-based — with no usage or dosing recommendation.
- Which peptide is better supported by science, Elamipretide or Terlipressin?
- The highest available evidence level is "Human RCT" for Elamipretide and "Human RCT" for Terlipressin. A higher evidence level means more robust data, but says nothing about suitability for an individual. The full body of evidence is on each peptide's own page.
- What is the legal status of Elamipretide and Terlipressin in Germany and the United States?
- Germany: Elamipretide — Unapproved, Terlipressin — Prescription. United States: Elamipretide — Prescription, Terlipressin — Prescription. These are factual summaries with source and review date on the individual pages.