What Is Teduglutide?

1. What is GLP-2, and how is it related to GLP-1?

GLP-1 and GLP-2 are both cut from proglucagon, the same precursor protein that gives rise to glucagon. They are released together from L cells in the lower small bowel and colon after a meal. That shared origin explains the similar names, but their jobs diverge.

According to Drucker and Yusta’s review, GLP-2 is a 33-amino-acid peptide whose levels rise quickly after eating. It acts through a single receptor, the GLP-2 receptor, found mainly in the gut. Its effects include:

• more blood flow to the intestine;
• faster growth and less cell death in the crypts, the pits where new lining cells are made, which enlarges the absorbing surface;
• a stronger gut barrier;
• slower stomach emptying and less stomach acid.

GLP-1, by contrast, acts on the GLP-1 receptor in the pancreas, brain and gut to raise insulin, lower glucagon and reduce appetite. Animals lacking GLP-2 signaling are more vulnerable to gut injury and adapt poorly after fasting, which points to GLP-2’s role as a maintenance signal for the bowel.

2. How does teduglutide work, and why is it different from natural GLP-2?

Natural GLP-2 is broken down within minutes by DPP-4, the same enzyme that clears GLP-1. Researchers found that GLP-2 analogs resistant to DPP-4 had stronger effects in animals (Drucker et al., 1999). Teduglutide is one of those analogs. It differs from human GLP-2 only at position 2, where a glycine replaces an alanine, which shields it from DPP-4 (Mardini and de Villiers).

The Gattex label adds these details:

• It is made in E. coli using recombinant DNA technology and weighs 3,752 daltons.
• It binds GLP-2 receptors in the intestine, which triggers release of IGF-1, nitric oxide and keratinocyte growth factor, local signals that drive tissue growth.
• Absolute bioavailability after an injection under the skin is 88%, with peak levels 3 to 5 hours after a dose.
• Half-life is about 2 hours in healthy people and 1.3 hours in people with short bowel syndrome. It does not accumulate with daily doses.
• It is cleared mainly by the kidneys, at a rate similar to kidney filtration. Kidney impairment raised exposure 1.5- to 2.6-fold, which is why the dose is halved when eGFR is below 60.

In trials, teduglutide raised blood citrulline, an amino acid made by gut lining cells that serves as a marker of how much working mucosa a person has (Jeppesen et al., 2012).

3. What is short bowel syndrome?

Short bowel syndrome happens when so much small intestine has been removed or lost that the rest cannot absorb enough water, electrolytes and nutrients. According to a 2025 review of intestinal failure care, Crohn’s disease is a frequent cause in adults and necrotizing enterocolitis, a severe bowel infection of newborns, in children. When the remaining bowel cannot sustain the person, it is called intestinal failure, and people need parenteral support: nutrition or fluids infused through a vein, often overnight, several days a week.

Parenteral support keeps people alive but carries a heavy burden, including hours connected to a pump and the risk of infection in the central line. In the STEPS-2 extension, catheter sepsis was reported in 28% of patients over two years (Schwartz et al.). After surgery the bowel adapts on its own for a period, growing taller villi and absorbing more. Teduglutide aims to push that adaptation further.

In the multinational SBS Registry, which enrolled 1,411 adults in 17 countries, Crohn’s disease was the most common reason for major bowel resection. The registry exists mainly to follow teduglutide’s long-term safety in routine care.

4. What did the adult trials show?

The pivotal STEPS trial

STEPS randomized 86 adults with short bowel syndrome and intestinal failure to teduglutide 0.05 mg/kg a day or placebo for 24 weeks. Every four weeks, IV volumes were cut if urine output had risen at least 10%, a sign the gut was absorbing more fluid. A responder was someone whose IV volume had fallen at least 20% at both week 20 and week 24.

The placebo response was substantial because the trial itself pushed doctors to reduce IV support whenever urine output rose. Teduglutide still roughly doubled the response rate.

The earlier dose-finding trial

An earlier 24-week trial by Jeppesen and colleagues compared 0.10 mg/kg, 0.05 mg/kg and placebo in 83 patients. The higher dose did not beat placebo on the trial’s main graded score, while the lower dose did. The label reports a 46% response at 0.05 mg/kg against 6% on placebo in that study. That is why 0.05 mg/kg became the approved dose.

Long-term extensions

Benefit grew with time. In STEPS-2, a 2-year open-label extension, 65 of 88 enrolled patients finished.

Thirteen patients achieved full enteral autonomy, meaning they no longer needed any IV support. Weight, body mass index and albumin stayed stable on average. In STEPS-3, 14 patients continued for one more year, up to 42 months in total, and two more became independent of IV support.

These extensions were open-label, had no control group and kept only people who stayed on treatment, so they likely flatter the results somewhat.

5. What about children?

The FDA added children 1 year and older on May 16, 2019 (Drugs@FDA). The main evidence is Kocoshis and colleagues’ 24-week phase 3 trial of 59 children aged 1 to 17.

Doses were blinded, but the standard-care arm was not, and families chose whether to join it. Fever and vomiting were the most common side effects on teduglutide.

A pooled analysis of 89 children followed for a median of about a year, and up to 161 weeks, found three serious events judged related to the drug: ileus (a stalled bowel), D-lactic acidosis and a blockage from hard stools. All resolved. One cecal polyp was seen and no cancers occurred. Smaller studies have also treated infants, and the EU label now starts at 4 months corrected gestational age (EMA).

6. Is teduglutide approved, and how is it dosed?

Sources: Drugs@FDA, Revestive EPAR, Teduglutide Viatris EPAR. As of our check in November 2026, the Drugs@FDA entry lists no therapeutic equivalent for Gattex, and we found no US generic.

The US label sets the labeled dose at 0.05 mg/kg once a day by injection under the skin for adults and children, rotating between the abdomen, thighs and upper arms. With an eGFR below 60 mL/min/1.73 m², including end-stage kidney disease, the dose is 0.025 mg/kg. Each single-dose vial contains 5 mg of powder, which is mixed with the supplied sterile water. A missed dose is taken the same day, and two doses are never taken on one day.

The dose does not change as IV support falls. What changes is the IV prescription, which the specialist team reduces step by step as urine output, weight and blood tests show the gut is absorbing more.

7. What are the side effects?

The label pools the two adult placebo-controlled trials:

Among adults with a stoma, gastrointestinal stoma complications occurred in 42% on teduglutide against 14% on placebo. That fits the drug’s effect of growing gut tissue.

About a third of adults developed antibodies to teduglutide by 2 years, and 48% by 30 months. Most cross-reacted with natural GLP-2, but the label found no clinically relevant link to safety or effect. A study of US adverse event reports from 2013 to 2023 flagged weight loss, catheter infections, dehydration and kidney problems among the most reported terms. Spontaneous reports cannot show cause, and many of those problems are common in intestinal failure itself.

8. What are the main warnings?

Growth of polyps and tumors

Teduglutide makes intestinal tissue grow, and that raises the question of whether it could speed up existing growths. In two-year rodent studies, high exposure caused more bile duct and small bowel adenomas in rats and gallbladder adenomas and small bowel cancers in male mice. In adult trials, three people on teduglutide were diagnosed with a cancer (label).

A 2018 systematic review by Ring and colleagues found no increased risk of intestinal neoplasia in humans treated for up to 30 months without pre-existing cancer, but called the data too small for a firm conclusion. In animals with an existing tumor, GLP-2 could promote its growth. The label’s monitoring rules reflect that:

Other warnings

• Bowel obstruction. Pause the drug if the intestine or stoma becomes blocked.
• Gallbladder and pancreas. Check bilirubin, alkaline phosphatase, lipase and amylase before starting and at least every 6 months. Cholecystitis and pancreatitis have been reported.
• Fluid overload. Better absorption means IV volumes must come down. Fluid overload and heart failure have occurred, and fluid and electrolytes are watched after stopping, too.
• Oral drugs. A gut that absorbs more may also absorb more medicine. One patient taking the benzodiazepine prazepam became comatose. Drugs with a narrow safety margin may need lower doses.

9. Can teduglutide be used with GLP-1 drugs?

No trial cited here has studied teduglutide with semaglutide, tirzepatide or any other GLP-1 drug, and the label does not name them. Some points are still worth knowing.

The two hormones were tested together, briefly. In a small crossover study by Madsen and colleagues, nine patients with short bowel syndrome received 72-hour IV infusions of natural GLP-1, GLP-2, both, or saline. All three active infusions cut stool losses. Only the treatments that included GLP-2 increased absolute fluid and sodium absorption. GLP-1 alone tended to cause nausea and reduced appetite, which was eased when GLP-2 was added.

A GLP-1 drug has been tried in short bowel syndrome. In an 8-week open-label pilot, liraglutide reduced stoma output by about 474 g a day in eight patients with an end-jejunostomy. That is a pilot without a control group, not an approved use.

Side effects can overlap. Both drug types slow stomach emptying, and nausea, bloating and abdominal pain appear on both labels. Teduglutide’s warning about increased absorption of oral medicines also matters for anyone adding other pills.

The goals differ. A GLP-1 drug reduces how much a person eats. Teduglutide helps a damaged gut absorb more of what is eaten. For someone with intestinal failure, appetite loss and weight loss from a GLP-1 drug could work against the goal of getting off IV nutrition, so any combination belongs with the intestinal failure team.

The two pathways have also been combined in one molecule. Zealand Pharma’s dapiglutide activates both receptors and was tested for weight loss before development was paused in November 2025.

A note on bone

GLP-2 also appears to affect bone. In Henriksen and colleagues’ 14-day trial in 60 postmenopausal women, GLP-2 injections reduced a blood marker of bone breakdown without changing markers of bone formation. Teduglutide is not approved for bone, and these are short-term marker studies. For bone-building drugs that are approved, see teriparatide and abaloparatide.

10. What are the newer GLP-2 drugs?

Teduglutide has to be injected daily because it clears in a couple of hours. Longer-acting GLP-2 analogs have been developed to cut that to weekly or twice-weekly dosing:

• Glepaglutide, from Zealand Pharma, is designed for once- or twice-weekly dosing and was tested in the EASE trials.
• Apraglutide, from Ironwood Pharmaceuticals, is a once-weekly analog tested in the STARS trial.

Neither was FDA-approved when we checked in November 2026; their pages cover the latest status.

11. What can you track on teduglutide?

The trials measured response in IV volume and days, so those are the core records. A clinician will typically want:

• IV support. Weekly volume and number of infusion days, with the date of each change.
• Fluid balance. Urine volume, stoma or stool output, body weight and signs of swelling or breathlessness.
• Lab results. Citrulline if measured, electrolytes, kidney function, bilirubin, alkaline phosphatase, lipase and amylase, with dates.
• Procedures. Dates and findings of colonoscopies and other scopes.
• Dose log. Daily injection time and site, and missed doses.
• Symptoms. Abdominal pain, bloating, nausea, stoma changes and any new oral medicines.

A peptide tracker or spreadsheet can keep that history in one place. It cannot show whether teduglutide is working; that judgment rests on the specialist team’s review of IV needs and lab results over months.

12. Teduglutide FAQ

• What is teduglutide used for?

  It is approved for short bowel syndrome in people who depend on parenteral support, meaning nutrition or fluids given through a vein. In the US the label covers adults and children 1 year and older. In the EU, Revestive and a generic version are authorized from 4 months corrected gestational age.

• Is teduglutide a GLP-1 drug?

  No. Teduglutide copies GLP-2, a different hormone cut from the same precursor protein as GLP-1. GLP-2 acts on its own receptor, found mainly in the gut, and its main job is to maintain and grow the intestinal lining. It does not lower blood sugar or cause the appetite loss and weight loss seen with GLP-1 drugs.

• Does teduglutide cause weight loss or weight gain?

  Neither is a goal of the drug. It helps the gut absorb more fluid and nutrients so IV support can be reduced. In the STEPS-2 extension, mean weight, body mass index and albumin stayed stable as IV support fell, although decreased weight was reported as an adverse event in 25% of patients.

• What are the side effects of Gattex?

  In placebo-controlled adult trials, abdominal pain, nausea, upper respiratory infections, abdominal swelling, injection-site reactions, vomiting and fluid overload were among the most common. People with a stoma had more stoma complications. The label also warns about faster growth of polyps or tumors, bowel obstruction, gallbladder and pancreas problems, and increased absorption of oral medicines.

• How long does teduglutide stay in your system?

  Per the US label, its half-life is about 2 hours in healthy adults and about 1.3 hours in people with short bowel syndrome, and it does not build up with daily dosing. Its effects on the gut lining last longer than the drug itself, which is why fluid balance is watched after stopping.

• Why does teduglutide require a colonoscopy?

  GLP-2 stimulates growth of the intestinal lining, and rodent studies found more gut and bile duct tumors at high exposure. The label asks for a colonoscopy within 6 months before starting in adults, again at 1 year, and then at least every 5 years. Children have stool blood tests yearly and a colonoscopy at 1 year.

• Can teduglutide be taken with semaglutide or tirzepatide?

  No study cited here tested the combination, and the label does not name GLP-1 drugs. Both drug types slow the gut and can cause nausea or bloating, and teduglutide can raise absorption of oral medicines. A combination would be a decision for the specialist team managing the intestinal failure.

• Is there a generic teduglutide?

  In the EU, the European Medicines Agency authorized a generic, Teduglutide Viatris, on January 8, 2026. As of November 2026 the Drugs@FDA entry for Gattex lists no therapeutic equivalent, and we found no FDA-approved US generic.

13. Sources