Inalossin (Nitric Oxide)

Inalossin is used as a pulmonary vasodilator to manage conditions involving elevated pulmonary vascular resistance.

• Pulmonary hypertension: reduces pulmonary arterial pressure and improves exercise capacity.
• Neonatal respiratory distress syndrome: facilitates pulmonary vasodilation and improves oxygenation in newborns with compromised lung function.
• Chronic thromboembolic pulmonary hypertension: lowers pulmonary vascular resistance and supports right‑ventricular function in chronic disease states.

• Inalossin releases nitric oxide directly within the pulmonary airways. The liberated nitric oxide diffuses into vascular smooth‑muscle cells, activates soluble guanylate cyclase, and increases cyclic GMP levels. Elevated cyclic GMP leads to smooth‑muscle relaxation, resulting in vasodilation of pulmonary vessels and reduced pulmonary arterial pressure.

Adverse reactions may occur with inhaled nitric oxide therapy and should be monitored.

Common Side Effects

• Headache: mild to moderate intensity.
• Flushing: transient skin warmth.
• Hypotension: drop in systemic blood pressure.
• Dizziness: sensation of light‑headedness.
• Nausea: occasional upset stomach.
• Cough: irritation of the airway.

Serious or Rare Side Effects

• Methemoglobinemia: elevated methemoglobin levels requiring intervention.
• Severe hypotension: marked drop in blood pressure needing urgent care.
• Pulmonary edema: fluid accumulation in lungs.
• Allergic reaction: rash, itching, or anaphylaxis.
• Hemolysis: destruction of red blood cells.
• Rebound pulmonary hypertension: worsening pressure after abrupt discontinuation.

Inalossin requires careful clinical oversight due to its potent vasodilatory effect.

• Blood pressure monitoring: check systemic and pulmonary pressures regularly.
• Specialized administration: use only with approved inhalation devices and trained personnel.
• Hypersensitivity: avoid in patients with known nitric oxide allergy.
• Anemia caution: monitor hemoglobin levels during therapy.
• Concomitant vasodilators: assess risk of additive hypotension.
• Store at ambient temperature: keep cylinders in original packaging, protect from heat and direct sunlight.

Inhaled nitric oxide can interact with other agents that affect vascular tone or hemoglobin.

Major Interactions (Avoid)

• Other potent vasodilators (e.g., nitroglycerin): risk of severe hypotension.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil): additive pulmonary vasodilation.
• Inhaled anesthetics that depress respiration: may exacerbate respiratory depression.
• Systemic hypotensive agents (e.g., ACE inhibitors): heightened blood pressure drop.
• Nitric oxide scavengers (e.g., methylene blue): antagonize therapeutic effect.

Moderate Interactions (Monitor Closely)

• Anticoagulants: increased bleeding tendency due to vascular effects.
• Hemoglobin‑modifying agents: may alter methemoglobin formation risk.
• Certain antibiotics (e.g., aminoglycosides): potential impact on nitric oxide metabolism.