Table 3:

Commonly used vasoactive medications and pulmonary vasodilators in PPHN

Name of drug	Dose	Site of action	Hemodynamic effects
Epinephrine	0.02–0.3 microgm/kg/min	β1 and β2 receptors	Inotropic effects; Decrease SVR
	0.3–1 microgm/kg/min	α1 receptors	Vasopressor effects; Increase SVR
Norepinephrine	0.1–1microgm/kg/min	α1 and α2 receptors	Vasopressor effects; Increase SVR
Milrinone	0.25–0.75 microgm/kg/min	Phosphodiesterase III inhibitor and effects at β1 & β2 receptors	Inodilator effects; Lusitropic effects; Increase contractility; Decrease SVR
Dobutamine	5–20 microgm/kg/min	β1 and β2 receptors, some effect on α receptors	Inotropic effects; Decrease SVR; Increase cardiac output
Dopamine	1–4 microgm/kg/min	Dopaminergic receptors 1 & 2	Renal and mesenteric dilatation
	4–10 microgm/kg/min	α receptors	Inotropic effects
	11–20 microgm/kg/min	β receptors	Vasopressor, increase SVR and increase PVR
Hydrocortisone	1–2.5 mg/kg; 4–6 hourly		Uncertain - enhance sensitivity to catecholamines
Vasopressin	0.018–0.12 units/kg/hour	Vasopressin 1 receptors	Increase SVR; No inotropic effect
Pulmonary vasodiators
Inhaled nitric oxide	1–20 ppm	Selective pulmonary vasodilator	Decrease PVR
Sildenafil	IV: load of 0.42 mg/kg for 3 hours followed by 1.6 mg/kg per day as a continuous maintenance infusion	Phosphodiesterase (PDE) 5 inhibitor	Pulmonary and systemic vasodilator; Decreases PVR, decreases SVR
	Oral: 1–2 mg/kg every 6 hours
Synthetic prostacyclin (Iloprost)	Aerosolized: 1–2.5 mg/kg every 2–4 hours	Pulmonary vasodilator acting locally	Decreases PVR
	IV 0.5 to 3 ng/kg per minute and titrated to 1–10 ng/kg per minute	Pulmonary and systemic vasodilator	Decreases SVR and hypotension
Prostacyclicn I2 (PGI2)	Inhaled prostaglandin I2 at a dose of 50 ng/kg per minute	Pulmonary vasodilator acting locally	Decreases SVR

SVR – systemic vascular resistance; PVR – pulmonary vascular resistance; α- alpha and β- beta receptors; IV - intravenous