Consensus of primary care in acute pancreatitis in Japan

Table 4 Recommended doses of protease inhibitors for acute pancreatitis[47]

	Mild and moderate	Severe
Protease inhibitor	FOY	FOY ＋ UTI
	FUT	FUT ＋ UTI
	UTI
Initial dose2 (during the first 12 h)	Maximum usual one- day dose1 by continuous intravenous infusion	Maximum usual one- day dose1 by continuous intravenous infusion
Until d 32	Above dose for 24 h	Above dose for 24 h
First wk2	Gradually reduce the above dose or intermittent administration	Above dose for 24 h
Second wk2	Reduce the dose or cease	Maintain or gradually reduce the above dose
Third wk2	Reduce the dose or cease	Maintain or gradually reduce the above dose

FOY: Gabexate mesilate, FUT: Nafamostat mesilate, UTI: Ulinastatin.

¹Administer the one-day dose during the initial 12 h.

²Severity stratification should be made repeatedly, and the doses of protease inhibitors must be increased or decreased depending on the severity. The usual daily dosage for acute pancreatitis of FOY, FUT and UTI approved by the health insurance is 200-600 mg, 10-60 mg and 50 000-150 000 units, respectively. Since, however, severe acute pancreatitis often complicates disseminated intravascular coagulation (DIC) and shock, it is recommended to give these reagents in doses that are approved for these disorders in severe acute pancreatitis (daily dosage for severe acute pancreatitis of FOY, FUT and UTI is 20-39 mg/kg body weight/d, 1.44-4.8 mg/kg body weight per day, and 10 000-300 000 units /d, respectively).