Nitric oxide
NO
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
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
NO BOXED WARNINGS
Principal riskRebound pulmonary hypertension on abrupt withdrawal
Classes and tags
Clinical profile
Mechanism of action: Nitric oxide ballicule
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Memory aids: mascots and interaction avatars
NO is produced by lightning in thunderstorms
antiseptic mouthwash may disrupt oral microbiome → possible deficit of NO-producing bacteria