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Nitric Oxide Dosage

Applies to the following strength(s): 100 ppm ; 800 ppm

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Pediatric Dose for:

Additional dosage information:

Usual Pediatric Dose for Respiratory Failure

Neonatal Hypoxic Respiratory Failure:

Neonates exceeding 34 weeks of age and less than 14 days old: The recommended dose of nitric oxide for inhalation is 20 ppm. Treatment should be maintained up to 14 days or until the underlying oxygen desaturation has resolved and the neonate is ready to be weaned from nitric oxide therapy.

Maximum Dose: Doses greater than 20 ppm ordinarily should not be used.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Nitric oxide should not be used in the treatment of neonates known to be dependent on right to left shunting of blood.

Abrupt discontinuation of nitric oxide may lead to worsening oxygenation and increasing pulmonary artery pressure. Wean off nitric oxide by titrating down in several steps and pausing several hours at each step to monitor for hypoxemia.

Methemoglobinemia increases with the dose of nitric oxide. In clinical trials, maximum methemoglobin levels usually were reached approximately 8 hours after initiation of inhalation, although methemoglobin levels have peaked as late as 40 hours following initiation of therapy. Following discontinuation or reduction of nitric oxide, the methemoglobin levels returned to baseline over a period of hours.

While there are no dose adjustments recommended for use in the treatment of neonates with renal dysfunction, it should be noted that nitrate is cleared from the plasma by the kidney at rates approaching the rate of glomerular filtration.

Dialysis

Data not available

Other Comments

Additional therapies should be used to maximize oxygen delivery. In patients with collapsed alveoli, additional therapies might include surfactant and high frequency oscillatory ventilation.

The safety and effectiveness of inhaled nitric oxide have been established in a population receiving other therapies for hypoxic respiratory failure including vasodilators, intravenous fluids, bicarbonate therapy, and mechanical ventilation.

Nitric oxide should be administered with monitoring for PaO2, methemoglobin, and NO2. Methemoglobin should be measured within 4-8 hours after initiation of treatment and periodically during treatment.

Nitric oxide must be administered using a Nitric Oxide Delivery System (includes a nitric oxide administration apparatus, a nitric oxide gas analyzer, and a nitrogen dioxide gas analyzer), by a healthcare professional who completed a comprehensive training program provided by the delivery system and drug manufacturers. Failure to calibrate the system could result in under or over dosing.

In the event of a system failure or wall outlet power failure, a backup battery power supply and reserve nitric oxide delivery system should be available.

Nitric oxide cylinders should be protected from shocks, falls, oxidizing and flammable materials, moisture, and sources of heat or ignition.

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