Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction

No interaction studies have been performed.
A clinically significant interaction with other medicinal products used in the treatment of hypoxic respiratory failure cannot be excluded based on the available data. There may be an additive effect with Mixture NO 800 ppm in Nitrogen on the risk of developing methaemoglobinemia with nitric oxide donor substances, including sodium nitroprusside and nitroglycerin .Mixture NO 800 ppm in Nitrogen has been safely administered with tolazoline, dopamine, dobutamine, steroids, surfactant, and high-frequency ventilation.

The combined used with other vasodilators (e.g. sildenafil) is not extensively studied. Available data suggest additive effects on central circulation, pulmonary artery pressure and right ventricular performance. Inhaled nitric oxide combination with other vasodilators acting by the cGMP or cAMP systems should be done with caution.

There is an increased risk of methaemoglobin formation if substances with a known tendency to increase methaemoglobin concentrations are administered concomitantly with nitric oxide (e.g. alkyl nitrates and sulphonamides). Substances known to cause increased methaemoglobin levels should thus be used with caution during therapy with inhaled nitric oxide. Prilocaine, whether administered as oral, parenteral, or topical formulations may cause methaemoglobinaemia. Care must be taken when Mixture NO 800 ppm in Nitrogen is given at the same time as medicinal products containing prilocaine.

In the presence of oxygen, nitric oxide is rapidly oxidized to derivatives which are toxic to the bronchial epithelium and alveolo-capillary membrane. Nitrogen dioxide (NO2) is the main substance formed, and may cause airway inflammation and damage. There are also animal data suggesting an increased susceptibility to airway infections upon exposure to low levels of NO2. During treatment with nitric oxide, the NO2 concentration should be < 0.5 ppm in the nitric oxide dose range < 20 ppm.
If at any time the NO2 concentration exceeds 1 ppm, the nitric oxide dose should immediately be reduced. See section 4.2 for information on monitoring for NO2.