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Selective Pulmonary Vasodilator

Nitric Oxide (Inhaled — iNO)

Brand names: INOmax, Noxivent

Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator delivered into the ventilator circuit, used in critical care for pulmonary hypertension and severe hypoxaemic respiratory failure, including persistent pulmonary hypertension of the newborn.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Delivered to ventilated lung units, it diffuses into pulmonary vascular smooth muscle and raises cyclic GMP to cause local vasodilatation, improving ventilation–perfusion matching while being rapidly inactivated by haemoglobin so systemic effects are minimal.

Prescribing in practice

  • It must never be stopped abruptly because rebound pulmonary hypertension and hypoxaemia can occur; wean gradually.
  • It can cause methaemoglobinaemia and generates toxic nitrogen dioxide, so inspired nitrogen dioxide and methaemoglobin must be monitored.
  • Delivery requires a dedicated, calibrated delivery and monitoring system integrated with the ventilator.

Monitoring

Monitor oxygenation, methaemoglobin levels, and inspired nitrogen dioxide concentration, and observe closely during weaning for rebound deterioration.

Counselling the patient

  • This therapy is delivered through the breathing machine and continuously monitored in intensive care.
  • The treatment is reduced gradually rather than stopped suddenly.

Evidence & guidelines

Use is supported by critical care and neonatal practice and product information; consult current prescribing references and the SPC.

Reference: Cochrane Review: iNO for ARDS (Adhikari et al. 2014); INNOVO Trial (Lancet 2002 — PPHN); MHRA SPC INOmax; ESC/ERS Pulmonary Hypertension Guidelines 2022; Surviving Sepsis Campaign 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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