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Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-.
CASRN: 10102-43-9
Drug Levels and Effects
Summary of Use during Lactation
No information is available on breastfeeding during the therapeutic use of nitric oxide by inhalation. Nitric oxide has a half-life of only a few seconds, so exogenously administered nitric oxide cannot reach the breastmilk. Nitric oxide is metabolized to methemoglobin and nitrate, which are present in the maternal systemic circulation. Although maternal nitrate serum levels may be elevated during nitric oxide administration,[1-3] this does not result in elevated breastmilk nitrate levels.[4,5] Both nitric oxide and nitrate are normal components of human milk,[6-8] and nitric oxide is administered directly to newborns by inhalation to treat respiratory failure. Given the above, it appears to be acceptable to breastfeed during maternal nitric oxide inhalation therapy.
Drug Levels
Maternal Levels. Relevant published information was not found as of the revision date.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
Relevant published information was not found as of the revision date.
Effects on Lactation and Breastmilk
Nitric oxide produced locally in the breast may have a role in the letdown reflex at the initiation of lactation. It results in high concentrations of nitrates and nitrites in breastmilk just prior to an increase in milk production.[9] Nitric oxide may also be involved with nipple erection.[10]
References
- 1.
- Valvini EM, Young JD. Serum nitrogen oxides during nitric oxide inhalation. Br J Anaesth. 1995;74:338–9. [PubMed: 7718385]
- 2.
- Preiser JC, De Backer D, Debelle F, et al. The metabolic fate of long-term inhaled nitric oxide. J Crit Care. 1998;13:97–103. [PubMed: 9758023]
- 3.
- Kostler WJ, Rabitsch W, Locker GJ, et al. Influence of inhaled nitric oxide on plasma nitrate concentrations in patients with adult respiratory distress syndrome and sepsis: Results of a pilot study. J Clin Anesth. 2006;18:179–84. [PubMed: 16731319]
- 4.
- Green LC, Tannenbaum SR, Fox JG. Nitrate in human and canine milk. N Engl J Med 1982;306:1367. Letter. PMID: 7070470. [PubMed: 7070470]
- 5.
- Greer FR, Shannon M., American Academy, of, Pediatrics, Committee, on, Nutrition, et al. Infant methemoglobinemia: The role of dietary nitrate in food and water. Pediatrics. 2005;116:784–6. [PubMed: 16140723]
- 6.
- Berens P, Bryan NS. Nitrite and nitrate in human breast milk: Implications for development. In, Bryan NS, Loscalzo J, eds. Nitrite and nitrate in human health and disease. New York. Humana Press. 2017:139-53. https://link
.springer .com/chapter/10.1007 %2F978-3-319-46189-2_11. - 7.
- Hord NG, Ghannam JS, Garg HK, et al. Nitrate and nitrite content of human, formula, bovine, and soy milks: Implications for dietary nitrite and nitrate recommendations. Breastfeed Med. 2011;6:393–9. [PMC free article: PMC3228598] [PubMed: 20958096]
- 8.
- Akcay F, Aksoy H, Memisogullari R. Effect of breast-feeding on concentration of nitric oxide in breast milk. Ann Clin Biochem. 2002;39:68–9. [PubMed: 11853194]
- 9.
- Iizuka T, Sasaki M, Oishi K, et al. Nitric oxide may trigger lactation in humans. J Pediatr. 1998;131:839–43. [PubMed: 9427887]
- 10.
- Tezer M, Ozluk Y, Sanli O, et al. Nitric oxide may mediate nipple erection. J Androl. 2012;33:805–10. [PubMed: 22207705]
Substance Identification
Substance Name
Nitric Oxide
CAS Registry Number
10102-43-9
Drug Class
Breast Feeding
Anti-Asthmatic Agents
Antioxidants
Autonomic Agents
Bronchodilator Agents
Cardiovascular Agents
Endothelium-Dependent Relaxing Factors
Free Radical Scavengers
Neurotransmitter Agents
Peripheral Nervous System Agents
Respiratory System Agents
Vasodilator Agents
Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
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- Review Nitrous Oxide.[Drugs and Lactation Database (...]Review Nitrous Oxide.. Drugs and Lactation Database (LactMed®). 2006
- Carboxyhemoglobin formation secondary to nitric oxide therapy in the setting of interstitial lung disease and pulmonary hypertension.[South Med J. 2011]Carboxyhemoglobin formation secondary to nitric oxide therapy in the setting of interstitial lung disease and pulmonary hypertension.Ruisi P, Ruisi M. South Med J. 2011 Jan; 104(1):46-8.
- Lack of alteration of endogenous nitric oxide pathway during prolonged nitric oxide inhalation in intensive care unit patients.[Crit Care Med. 2005]Lack of alteration of endogenous nitric oxide pathway during prolonged nitric oxide inhalation in intensive care unit patients.Lukaszewicz AC, Mebazaa A, Callebert J, Matéo J, Gatecel C, Kechiche H, Maistre G, Carayon A, Baudin B, Payen D. Crit Care Med. 2005 May; 33(5):1008-14.
- Effects of inhaled nitric oxide following lung transplantation.[J Card Surg. 2009]Effects of inhaled nitric oxide following lung transplantation.Yerebakan C, Ugurlucan M, Bayraktar S, Bethea BT, Conte JV. J Card Surg. 2009 May-Jun; 24(3):269-74.
- Review The interaction between nitrogen oxides and hemoglobin and endothelium-derived relaxing factor.[Free Radic Biol Med. 1989]Review The interaction between nitrogen oxides and hemoglobin and endothelium-derived relaxing factor.Kosaka H, Uozumi M, Tyuma I. Free Radic Biol Med. 1989; 7(6):653-8.
- Nitric Oxide - Drugs and Lactation Database (LactMed®)Nitric Oxide - Drugs and Lactation Database (LactMed®)
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