Do you avoid terlipressin for patients with hepatorenal syndrome who have a serum sodium level less than 125 mEq/L?

This is a good question and I'll admit I don't have much first-hand experience using terlipressin. However, terlipressin is relatively (6X) selective for V1 vs V2 receptors and is used for its vasoconstrictor actions in HRS. Although there are reports (mostly retrospective and uncontrolled case seri...

I would avoid using terlipressin in patients with HRS who have a serum sodium <125 mEq/L. Since terlipressin may act on the vasopressin V2 receptor, it may worsen hyponatremia.