Nitric Oxide
Mechanism :
Nitric oxide gas is a drug administered by inhalation. Nitric oxide relaxes vascular smooth muscle by binding to the heme moiety of cytosolic guanylate cyclase, activating guanylate cyclase and increasing intracellular levels of cyclic guanosine 3´,5´-monophosphate, which then leads to vasodilation. When inhaled, nitric oxide produces pulmonary vasodilation.
Indication :
- Hypoxic respiratory failure
- Chronic lung disease prevention
- Cystic fibrosis
Contraindications :
Contraindicated in the treatment of neonates known to be dependent on right-to-left shunting of blood.
Dosing :
Hypoxic respiratory failure:
>34 weeks gestation: Start at 20 ppm, inhaled for upto 2 weeks.
Adverse Effect :
Methemoglobinemia, hypotension, withdrawal, pulmonary edema.
Interaction :
Sodium nitroprusside and nitroglycerin: May have an additive effect with the risk of developing methemoglobinemia.
Prilocaine: An increased risk of methemoglobinemia.
Hepatic Dose :
No dosage adjustments are recommended.