Review Article

Pharmacological Treatment for Hepatopulmonary Syndrome

Table 1

Summary of human studies using pharmacologic agents for the treatment of hepatopulmonary syndrome.

StudyPatientsAge
(year)
Male/femaleDrug Dose DurationOutcome

Gupta et al. [32]9 patients with cirrhosis 405/4PTX400 mg 3 times/day 3 months(i) Improvement of clinical symptoms
(ii) Improvement of PaO2
(iii) Decreased TNF-α
Kianifar et al. [33]10 pediatric patient with cirrhosis 6/4PTX20 mg/kg/day3 months (i) Increase in PaO2 and A-a PaO2
(ii) Improvement of O2 saturation
(iii) No Improvement in Clinical symptoms
Tanikella et al. [34]9 patients with cirrhosis 3/6PTX (i) 400 mg/day
(ii) 400 mg twice/day
(iii) 400 mg 3 times/day
(i) 7days
(ii) 7 days
(iii) 42 days
(i) No significant change in PaO2
(ii) No significant change in A-a PaO2
(iii) No significant change in TNF-α
Rolla et al. [40] 1 patient with alcoholic cirrhosis45 FemaleMB3 mg/kg intravenous One bolus dose(i) Improvement in PaO2
(ii) Improvement in O2 saturation
Schenk et al. [41] 7 patients with liver cirrhosis 525/2MB3 mg/kg intravenousOne bolus dose in 15 minutes(i) Improvement of PaO2
(ii) Improvement of A-a PaO2
(iii) Increased mean pulmonary arterial pressure and pulmonary vascular resistance  
Jounieaux et al. [42] 1 patient with alcoholic cirrhosis61Male MB3 mg/kg intravenousOne bolus dose(i) Increased mean pulmonary arterial pressure
(ii) No change in shunt fraction
Roma et al. [43] 1 liver transplant patient for AIH15FemaleMB3 mg/kg intravenousOne bolus dose in 15 minutes(i) Increased O2 saturation
(ii) As abridge for weaning of from ventilator
Añel and Sheagren [52]1 patient with cirrhosis44Male Norfloxacin400 mg 2 times/day4 weeks (i) Increased O2 saturation
(ii) Resolution of platypnea and orthodeoxia
Gupta et al. [53] 11 patients with cirrhosis 8/1Norfloxacin400 mg 4 times/day1 month (i) No improvement in HPS
Caldwell et al. [54]1 patient with cirrhosis 60 Female Garlic4 teaspoons 4 times/day 4 months(i) Improvement of cyanosis
(ii) Increased PaO2
Abrams and Fallon [55]15 patients with cirrhosis NA7/8Garlic2 Capsule (500 mg) 2 times/day6 months (i) Increased PaO2
(ii) Deceased A-a PaO2
(iii) Decreased dyspnea on exertion 
Sani et al. [56]15 pediatric patients with cirrhosis 10/5Garlic0.5–2 g/1.73 m2 per day.4 weeks(i) Increased PaO2
(ii) Improvement of dyspnea
De et al. [57] 41 cirrhotic patients, 21 patients received garlic, 20 received placebo 17/4 Garlic1 capsule (250 mg) 2 times/day 18 months(i) Increased PaO2
(ii) Deceased A-a PaO2
(iii) Reversal of HPS in 14 from 21 patients
Maniscalco et al. [63]1 patient with cryptogenic cirrhosis31Male L-NAME8 mg/kg
in normal saline
Intravenously over 5 minutes(i) Decreased NO production
(ii) No improvement in arterial oxygenation
(iii) No improvement in orthodeoxia
Gómez et al. [64] 10 cirrhotic patients with HPS 7/3L-NAMESingle dose, 162.0 mg
dissolved in 4.0 mL 0.9% saline
Nebulized over 12 minutes(i) Decreased exhaled NO
(ii) Increased systemic vascular resistance
(iii) No change in ventilation/perfusion mismatch, intrapulmonary shunting, nor arterial oxygenation
Moreira Silva et al. [75]1 patient with autoimmune lymphoproliferative syndrome13 MaleMMFL500 mg twice/day9 months(i) Improvement of cyanosis, clubbing, and spider nevi
(ii) Normalization of PaO2
(iii) No need for supplemental oxygen
(iv) Improvement of intrapulmonary shunt
Yilmaz et al. [76]1 patient with
noncirrhotic
portal
hypertension
18MaleParoxetine 20 mg/day6 months(i) No significant improvement
Krug et al. [82]1 patient with alcoholic cirrhosis46 FemaleInhaled iloprost 30 µg/day
nebulized
2 months (i) Decreased subjective dyspnea
(ii) Increased exercise tolerance
(iii) Increase in PaO2
Krowka et al. [84]22 patients with cirrhosis or chronic active hepatitis (8 patients received the drug) 4912/10Somatostatin analogue 150 µg every 8 hours subcutaneously 4 days (i) No improvement in subjective dyspnea
(ii) No improvement in arterial oxygenation at the end of study

HPS: hepatopulmonary syndrome, PTX: pentoxifylline, MB: methylene blue, PaO2: arterial oxygen pressure, and A-a PaO2: alveolar-arterial oxygen gradient.
MMF: mycophenolate mofetil, L-NAME: NG-nitro-L-arginine methyl ester, and NO: nitric oxide.