Inhaled nitric oxide

Administration

  • Type: Inhalational agent
  • Dosage Forms: Metal cylinders, 100 ppm and 800 ppm
  • Routes of Administration: Inhaled
  • Common Trade Names: INOmax

Adult Dosing

5 - 80 ppm

Pediatric Dosing

20 ppm

Special Populations

Renal Dosing

  • Adult:
  • Pediatric:

Hepatic Dosing

  • Adult:
  • Pediatric:

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

  • Hypotension
  • Inhibits platelets - bleeding
  • Rebound htn and hypoxia
  • Renal failure

Common

  • Hypotension
  • Withdrawal

Pharmacology

  • Half-life: 5 seconds
  • Metabolism: reacts with oxyhemoglobin to form methemoglobin and nitrate, and also reacts with deoxy-hemoglobin.
  • Excretion: Renally; 70% of inhaled NO excreted within 48 hrs as nitrate in urine

Mechanism of Action

  • Acts via diffusion from alveoli
  • Relaxes smooth muscle of pulmonary vessels via conversion of GTP to cGMP, which activates a phosphorylatio cascade
  • Enhances V/Q matching by increasing blood flow to well-ventilated areas of lung
  • Decreases PVR
  • Decreases PA pressure

Indications

  • Pulmonary hypertension of newborn
  • Pulmonary hypertension of adults
  • Cystic Fibrosis
  • ARDS
  • Right heart failure (post-VAD, transplant, post cardiac surgery)
  • Graft failure post lung transplant

Comments

See Also

References

  • Ichinose F, Roberts JD Jr, Zapol WM. Inhaled nitric oxide: a selective pulmonary vasodilator: current uses and therapeutic potential. Circulation. 2004 Jun 29;109(25):3106-11. Review. PubMed PMID: 15226227.
  • Medscape