Table 5.

Treatment options for hepatopulmonary syndrome.

Prostacyclin analogues	Potent pulmonary and systemic vasodilators Antagonist of platelet aggregation Epoprostenol is the most commonly used drug in this class, is efficacious, but has several adverse effects related to safety, tolerability, and route of administration (short half-life, requiring the insertion of central venous access) Nebulized iloprost, 6–9 times a day, has shown improved symptoms, exercise tolerance, and functional capacity Treprostinil, a stable and long-acting prostacyclin analogue, can be administered subcutaneously and intravenous
Endothelin antagonist	Bosentan, a nonselective ET-1 receptor antagonist, improves exercise tolerance, functional capacity, and pulmonary hemodynamics, but also can worsen hepatic dysfunction and deteriorate renal failure especially in patients with type 2 HRS Ambrisentan: a selective ETA receptor antagonist, oral and once a day administration, with minimal hepatotoxicity risk
Phosphodiesterase-5-inhibitors	Sildenafil and tadalafil, their use results in an increased NO-mediated vasodilatation in the pulmonary vasculature
Vasopressin analogues	Terlipressin: several reports have shown that the administration of terlipressin decreases pulmonary artery pressure in cirrhotic patients with mild pulmonary hypertension, and reduces portal pressure, improves hyperdynamic circulation and functional renal failure via stimulation of mesenteric V1 receptors [12]