Inhaled alternatives to nitric oxide.

OBJECTIVE Inhaled nitric oxide has gained an established place in the management of pulmonary hypertension. However, cost, potential toxicity, and the lack of positive outcome data with inhaled nitric oxide therapy has generated interest in alternative inhaled, selective pulmonary vasodilators. This article describes those alternatives that have been studied to date. DESIGN Literature review of inhaled, selective pulmonary vasodilators other than nitric oxide. METHODS A review of the molecular mechanisms, potential side effects, and the studies to date in both animal models and clinical studies describing the physiologic effects of alternative agents to inhaled nitric oxide. CONCLUSION There are a number of available agents that have comparable physiologic effects as inhaled nitric oxide. The best studied of these are the inhaled prostanoids (prostacyclin and iloprost), and there is growing interest in novel therapies such as phosphodiesterase inhibitors and neuropeptides.