Nitric Oxide

Class: Nitrates and Nitrites
VA Class: CN201
Chemical Name: nitric oxide
Molecular Formula: NO
CAS Number: 10102-43-9
Brands: Genosyl, INOmax

Medically reviewed by Drugs.com on Mar 28, 2022. Written by ASHP.

Introduction

Vasodilating agent.

Uses for Nitric Oxide

Neonatal Hypoxic Respiratory Failure

Used in conjunction with ventilatory support and other appropriate therapy to improve oxygenation and reduce the need for extracorporeal membrane oxygenation (ECMO) in term or near-term (>34 weeks’ gestation) neonates with hypoxic respiratory failure and clinical or ECG evidence of pulmonary hypertension.

Most effective in patients with severe persistent pulmonary hypertension who have minimal underlying parenchymal lung disease (idiopathic persistent pulmonary hypertension).

Least effective in neonates with pulmonary hypoplasia (e.g., congenital diaphragmatic hernia).

Has been used with good results (i.e., decreased the incidence of severe intraventricular hemorrhage and periventricular leukomalacia) in premature neonates† (<34 weeks’ gestation) undergoing mechanical ventilation for respiratory distress syndrome.

Prevention of Bronchopulmonary Dysplasia

Not recommended for prevention of bronchopulmonary dysplasia† in preterm neonates ≤34 weeks’ gestational age requiring respiratory support; has not been shown to provide a meaningful difference with regard to mortality reduction and need for supplemental oxygen.

Acute Respiratory Distress Syndrome

Manufacturers state that inhaled nitric oxide is not indicated for use in acute respiratory distress syndrome (ARDS)†. However, has been used in adults and children with ARDS, generally as rescue therapy for refractory hypoxemia.

Treatment of ARDS is largely supportive; mechanical ventilation is the only intervention proven to reduce mortality. Inhaled nitric oxide may be used adjunctively to improve oxygenation; localized effects in the lung may improve ventilation-perfusion mismatch.

May temporarily improve oxygenation, but no effect on mortality and possible harm (e.g., renal impairment) demonstrated. Routine use of inhaled nitric oxide not recommended for treatment of ARDS; however, may be considered in selected patients with severe hypoxemia not responsive to conventional ventilation strategies, documented pulmonary hypertension, or severe right ventricular dysfunction.

Risk of renal toxicity appears to be increased with higher concentrations and/or prolonged use; therefore, use minimum effective concentration necessary to improve the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂ /FiO₂ ) and minimize duration of exposure.

Nitric Oxide Dosage and Administration

General

• Use only under supervision of a clinician experienced in the use, administration, and hazards of gas mixtures.

• Monitor inspired nitrogen dioxide and PaO₂ concentrations during administration. Periodic measurement of methe...