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nitric oxide

R07AX01

Forms & Strengths

Inhalation gas: 100 ppm, 800 ppm in cylinders

Adult Dosing

Persistent pulmonary hypertension of the newborn (PPHN): Initial 20 ppm, titrated up to 80 ppm as needed
Adult ARDS/Pulmonary hypertension off-label: Initial 5-20 ppm, titrated based on clinical response

Pediatric Dosing

Neonates (term and near-term): Initial dose 20 ppm, maintained for up to 14 days or until resolution of hypoxemia

Indications

Treatment of persistent pulmonary hypertension of the newborn (PPHN)
Improvement of oxygenation and reduction of the need for extracorporeal membrane oxygenation (ECMO) in term and near-term neonates

Mechanism of Action

Relaxes vascular smooth muscle by binding to the heme moiety of cytosolic guanylyl cyclase, activating it and increasing intracellular cGMP levels
Produces pulmonary vasodilation upon inhalation; due to rapid scavenging by hemoglobin, systemic vascular resistance is largely unaffected

Contraindications

Neonates dependent on right-to-left shunt of blood
Neonates with significant left ventricular dysfunction

Adverse Reactions

Methemoglobinemia
Elevated nitrogen dioxide (NO2) levels
Hypotension
Thrombocytopenia
Withdrawal hypoxemia (rebound pulmonary hypertension upon abrupt discontinuation)

Drug Interactions

Concomitant use with other nitric oxide donors (e.g., sodium nitroprusside, nitroglycerin) may increase the risk of methemoglobinemia and hypotension
Increased risk of methemoglobinemia when used with other agents associated with methemoglobinemia (e.g., prilocaine, local anesthetics)

Curated Content: Needs Vetting Before Put to Clinical Use