Paroxetine for hepatopulmonary syndrome?

Hepatopulmonary syndrome (HPS) is a severe pulmonary sequela which can affect up to 15% of patients with cirrhotic liver disease. There is no treatment for HPS other than liver transplantation. The cause of HPS is incompletely understood, but the pulmonary vasodilation in HPS is thought to be related to increased levels of nitric oxide. We therefore suggest that, the extremely safe and commonly used antidepressant medication paroxetine (Paxil) which is a potent nitric oxide synthase (NOS) inhibitor be considered for use in HPS.