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Inhaled nitric oxide
From WikEM
Contents
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-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
