OH Epic Formulary restricted to:

• Service line: Nephrology
• Formulary location: Inpatient
• Service location: Inpatient
• Patient population: Adults
• Prior authorization required: N/A
• Restriction/criteria of use (all will apply unless specified):
  • At the time of treatment initiation, patient MUST have all three criteria:
    • Confirmed diagnosis of HRS-AKI,
    • SCr of 2.25-5 mg/dL, AND
    • SpO2 ≥ 90% on room air or supplemental oxygen on a chronic stable condition (e.g., COPD)
  • Octreotide/midodrine should be discontinued at the start of terlipressin.
  • Discontinue therapy if:
    • SpO₂ decreases below 90% on room air or supplemental oxygen on a chronic stable condition (e.g., COPD) during therapy OR
    • Maximum duration of 14 days is reached OR
    • 24 hours after two consecutive SCr values of ≤ 1.5 mg/dL are achieved ≥ 2 hours apart OR
    • Patient is transferred to ICU.

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