Nitric oxide
NO
“Knight trick (or-treating) Ox”
NO is produced by lightning in thunderstorms
antiseptic mouthwash may disrupt oral microbiome → possible deficit of NO-producing bacteria
What it isEndogenous gaseous signaling molecule; inhaled for persistent pulmonary hypertension of the newborn.
Why this oneInhaled delivery dilates only ventilated lung, improving matching without systemic hypotension.
What limits itRebound pulmonary hypertension on abrupt withdrawal. Methemoglobinemia; nitrogen dioxide formation must be monitored.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypoxic respiratory failure with pulmonary hypertension (term/near-term neonates >34 wk gestation), with ventilatory support | Neonates | 20 ppm inhaled | 20 ppm (doses >20 ppm not recommended) |
Renal Undefined
Hepatic Undefined
Doses >20 ppm not recommended
Instructions
- Administer via a calibrated, FDA-cleared Nitric Oxide Delivery System (NODS)
- Maintain up to 14 days or until oxygen desaturation resolves
- Avoid abrupt discontinuation; wean by downtitration in steps
- Measure methemoglobin 4-8 h after initiation and periodically
Available strengths
- gas 800, 4880 ppm
Contraindications
- Neonates dependent on right-to-left shunting of blood
Cautions
- Rebound pulmonary hypertension on abrupt discontinuation
- Methemoglobinemia (dose-dependent)
- Elevated NO2 (airway inflammation/lung injury)
- Worsening heart failure in pre-existing left ventricular dysfunction
Adverse reactions
- Hypotension
Pregnancy Undefined
Lactation Undefined
Cost
Nitric oxide (NO)
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 800 ppm | gas | per unit | not offered | |
| 4880 ppm | gas | per unit | not offered |
NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Nitric oxide is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.
NO BOXED WARNINGS
Principal riskRebound pulmonary hypertension on abrupt withdrawal
Classes and tags
Clinical profile
Defining liabilityMethemoglobinemia, NO2 airway injury and rebound pulmonary hypertension