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

• Pregnancy Rating: C
• Lactation risk: Unknown

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

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