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Teduglutide

Also known as: Gattex, Revestive, ALX-0600, GLP-2 analog, glucagon-like peptide-2 analog, teduglutide acetate

Synthetic glucagon-like peptide-2 (GLP-2) analog; intestinal growth factor; trophic hormone

Research chemicalLast updated: October 10, 2026Based on 4 peer-reviewed studiesPreclinical data only — no human trials
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What it is

Teduglutide (Gattex in the US, Revestive in Europe) is a daily injection for people with short bowel syndrome — a serious condition where most of the small intestine has been removed, leaving patients dependent on IV nutrition bags for survival. It regrows the remaining gut lining so the intestine can absorb more nutrients, potentially reducing or eliminating IV feedings. FDA-approved since 2012.

The scientific side

teduglutide is a synthetic analog of endogenous glucagon-like peptide-2 (GLP-2), a 33-amino acid hormone secreted by enteroendocrine L-cells in the small intestine and colon in response to luminal nutrients. Native GLP-2 has a very short half-life of approximately 7 minutes due to rapid cleavage by the enzyme dipeptidyl peptidase-4 (DPP-4). Teduglutide incorporates a single amino acid substitution (alanine to glycine at position 2) that renders it resistant to DPP-4 degradation, extending its plasma half-life to approximately 2 hours and enabling effective once-daily subcutaneous dosing. Teduglutide acts as a full agonist at the GLP-2 receptor, which is expressed throughout the gastrointestinal tract — including intestinal epithelium, submucosal neurons, and enteric fibroblasts. Receptor activation exerts potent trophic effects on the intestinal mucosa: it stimulates crypt cell proliferation and inhibits apoptosis, resulting in measurable increases in villus height, crypt depth, and total mucosal surface area. These structural changes enhance absorptive capacity for fluids, electrolytes, and macronutrients in the remaining bowel. Beyond epithelial proliferation, teduglutide reduces gastric acid secretion, slows intestinal transit time, and promotes blood flow to the intestinal mucosa via vasoactive intestinal mechanisms. In patients with short bowel syndrome, these combined actions accelerate and augment the natural process of intestinal adaptation — the spontaneous compensatory growth of the remnant bowel that occurs following extensive resection. Clinical biomarker data confirm that teduglutide increases plasma citrulline levels (a validated proxy for functional enterocyte mass), with citrulline elevation correlating inversely with reductions in parenteral support volume (PMID 31784300). Network meta-analysis of 23 clinical trials encompassing 843 patients demonstrated that teduglutide at 0.1 mg/kg/day produced the highest citrulline response (mean difference 14.77 µmol/L; 95% CI) compared to other GLP-2 analogs, while 0.05 mg/kg/day is the FDA-approved dose balancing efficacy and tolerability (PMID 38663565). The net clinical outcome is a significant reduction in parenteral nutrition volume requirements, and in a meaningful proportion of patients, full enteral autonomy — independence from intravenous nutrition.

Class: Synthetic glucagon-like peptide-2 (GLP-2) analog; intestinal growth factor; trophic hormone

Administration & storage

Administration
Subcutaneous injection into the abdomenthighsor upper armsPen injector device also evaluated for bioavailability vs. standard syringe (NCT04465396Phase I); bioavailability confirmed equivalentRotate injection sites; do not inject into areas with lipodystrophyedemaor skin lesions
Storage
Unreconstituted vials: refrigerate at 2–8°C (36–46°F); do not freeze. Reconstituted solution: use within 3 hours; do not refrigerate after reconstitution. Discard unused portion.
Cautions
CONTRAINDICATED in patients with active gastrointestinal malignancy (colorectal cancer, small bowel cancer) or known history of GI malignancy within 5 years — teduglutide's trophic effects could accelerate tumor growth.,Mandatory colonoscopy screening before initiation: trophic stimulation of colorectal mucosa creates risk of polyp growth and potential malignant progression (PMID 34291485, 37409717).,Fluid and electrolyte overload: intestinal fluid absorption increases rapidly after starting teduglutide; parenteral support volumes MUST be reduced in parallel to prevent fluid overload and heart failure decompensation. Monitor closely, especially in patients with cardiac or renal disease.,Biliary/pancreatic effects: GLP-2 receptor activation can affect gallbladder and pancreas; monitor for cholestasis, gallstones, or pancreatitis.,Intestinal obstruction: bowel obstruction reported; monitor for new or worsening abdominal symptoms.,Common gastrointestinal adverse events (abdominal pain, nausea, abdominal distension) reported in ~40% of patients early in treatment; frequency declines with continued therapy (PMID 32341691).,Stoma complications (output changes, high-output stoma) observed with SBS patients; monitor stoma patients closely during dose initiation and titration.

Legal & regulatory status

US FDA

FDA-approved (BLA) as Gattex (teduglutide) 5 mg subcutaneous injection for adults with short bowel syndrome dependent on parenteral support. Initial approval December 2012. Pediatric approval extended in 2019 for…

WADA

Teduglutide is not listed on the current WADA Prohibited List. It is a prescription-only therapeutic agent used exclusively under medical supervision for intestinal failure and has no established performance-enhancing…

Health Canada

Approved as Revestive (teduglutide) in Canada for adults with short bowel syndrome who are dependent on parenteral nutrition. Canadian approval followed the European Medicines Agency authorization under the same brand…

EMA_Europe

Approved as Revestive by the European Medicines Agency (EMA) for adults with short bowel syndrome dependent on parenteral support. Revestive designation was part of the original marketing authorization in the EU.