Last Updated: August 9, 2026

CLINICAL TRIALS PROFILE FOR NITRIC OXIDE


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505(b)(2) Clinical Trials for nitric oxide

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
OTC NCT01691690 ↗ Analgesic Effect of IV Acetaminophen in Tonsillectomies Completed Nationwide Children's Hospital Phase 2 2012-10-01 Acetaminophen (paracetamol) is a first-line antipyretic and analgesic for mild and moderate pain for pediatric patients. Its common use (particularly in oral form) is underscored by its wide therapeutic window, safety profile, over the counter accessibility, lack of adverse systemic effects (as compared with NSAIDS and opioids) when given in appropriate doses. Although the exact anti-nociceptive mechanisms of acetaminophen continue to be elucidated, these mechanisms appear to be multi-factorial and include central inhibition of the cyclo-oxygenase (COX) enzyme leading to decreased production of prostaglandins from arachidonic acid, interference with serotonergic descending pain pathways, indirect activation of cannabinoid 1 (CB1) receptors and inhibition of nitric oxide pathways through N-methyl-D-aspartate (NMDA) or substance P. Of the above mechanisms, the most commonly known is that of central inhibition of COX enzymes by which the decreased production of prostaglandins diminish the release of excitatory transmitters of substance P and glutamate which are both involved in nociceptive transmission (Anderson, 2008; Smith, 2011). To date, several studies have shown acetaminophen's opioid sparing effect in the pediatric population when given by the rectal or intravenous routes (Korpela et al, 1999; Dashti et al, 2009; Hong et al, 2010).
OTC NCT02675660 ↗ Single and Multiple Doses of an Oral Formulation of L-Homoarginine in Healthy Human Subjects Completed Universitätsklinikum Hamburg-Eppendorf Phase 1 2014-04-01 This study represents an initial clinical evaluation of an oral formulation of L-homoarginine. L-homoarginine and L-arginine are amino acids found in food proteins and are both substrates for nitric oxide synthase (NOS). L-arginine is available as over the counter nutraceutical. This study will provide information on the dosing of L-homoarginine in order to reach high physiological plasma concentrations in humans.
OTC NCT03878654 ↗ Trial of Tauroursodeoxycholic Acid (TUDCA) in Asthma Terminated University of Vermont Phase 1 2019-01-10 Asthma is a chronic lung disease that affects millions of people worldwide, including both children and adults. The cause of asthma is not known, but asthma is strongly associated with inflammation of the airways, often caused by allergies. In order to control this inflammation, most people with asthma are treated with inhaled medications that contain steroids. These medications do a good job of helping most people with asthma feel better. However, these medications are expensive, have side effects, and do not control symptoms in all people with asthma. Recently basic science research colleagues have shown that inflammation due to allergies can be reduced in experimental animals by a naturally occurring bile acid. Bile acids are chemicals made in the liver that are involved in maintaining healthy digestion of fat. Since bile acids are made by our bodies, they have become popular as over the counter supplements that are thought to be important in promoting a healthy liver and metabolism. Interestingly, other research has shown that bile acids may help patients with neurological disease and diabetes. Given all of this information, the investigators propose that a specific bile acid called tauroursodeoxycholic acid (TUDCA) may be helpful in patients with asthma. Before studying this in a clinical trial, the current study is designed to demonstrate that people with asthma can take TUDCA safely and that it doesn't hurt their asthma. The study will involve inviting 12 patients with mild asthma to take TUDCA daily for 12 weeks. During this time the investigators will closely monitor them for any side effects and check their blood and breathing capacity for any signs of detrimental effects. In addition, the investigators will collect cells that line the nose, which are thought to be similar to cells in the airways of the lungs, to see if TUDCA is having any beneficial effects on inflammation. In order to ensure the use of high quality TUDCA, which may or may not be true of over the counter supplements, the investigators have asked the company that is supplying TUDCA for the studies mentioned previously involving neurological disease and diabetes to supply the drug; the brand name is Taurolite. In addition, even though TUDCA is available over the counter, in order to use it for research, the FDA has to approve this use. Accordingly, the investigators have applied for and received permission (IND) from the FDA to use Taurolite for this study.
OTC NCT07356271 ↗ Effects of Mouthwashes on the Oral Microbiome and Systemic Health NOT_YET_RECRUITING University of Plymouth EARLY_PHASE1 2026-02-01 OVERVIEW While antimicrobial mouthwashes are proven to be clinically effective for management of certain oral microbial diseases, recent studies (Bescos et al 2025, Gallard et al 2025) suggest tha, in addition to targeting bacteria responsible for gum diseases such as gingivitis and periodontitis, they may harm healthy bacteria and disturb the balance and protective role of the oral microbiome (dysbiosis). Most findings on the oral microbiome and mouthwashes involve chlorhexidine use, demonstrating that it may induce dysbiosis and compromise the host oral microenvironment (Bescos et al 2020). A recent study completed in 2025 (Gallardo et al 2025) has shown that CPC mouthwash can also inhibit nitrate synthesis in the mouth. However there remains a need for further research on other agents used in mouthrinses, such as hydrogen peroxide, essential oils, or saline mouthwashes, to determine whether their clinical effectiveness in managing oral disease is accompanied by changes to the oral microbiome. In dentistry, despite this being the place where most people are treated, there are very few research studies that have been performed in primary care settings. Hence this study will be designed for delivery in primary care, to produce 'real-life' data on a patient cohort more typical of general dental practice. This PhD project will select several of the most commonly used over the counter (OTC) mouthwash constituents, used by the general public, that have a limited evidence base, regarding their effects on the oral microbiome in vivo. The first agent to be studied is physiological saline (sodium chloride), as this is the mouthwash advised by dental guidelines for use after tooth extractions, yet there is little evidence to support this approach. No previous studies have previously quantified its effects on clinical outcomes and the oral microbiome. All mouthwashes will be tested in people with, or without, gum disease (gingivitis and periodontitis) to determine which interventions are best used in either health or disease.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for nitric oxide

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000577 ↗ Asthma Clinical Research Network (ACRN) Withdrawn National Heart, Lung, and Blood Institute (NHLBI) Phase 3 1993-09-01 This study will establish a network of interactive asthma clinical research groups to evaluate current therapies, new therapies, and management strategies for adult asthma.
NCT00000577 ↗ Asthma Clinical Research Network (ACRN) Withdrawn Milton S. Hershey Medical Center Phase 3 1993-09-01 This study will establish a network of interactive asthma clinical research groups to evaluate current therapies, new therapies, and management strategies for adult asthma.
NCT00001303 ↗ Effects of Endotoxin in Normal Human Volunteers Completed National Institutes of Health Clinical Center (CC) Phase 1 1992-04-06 Bacterial infections can progress to a life-threatening illness called septic shock, characterized by low blood pressure and vital organ damage. The syndrome is thought to be caused by parts of the bacteria and by the body s own immune response to the infection. A major bacterial product that interacts with the immune defenses is called endotoxin. This study will examine the body s response to endotoxin in the lungs or bloodstream. When endotoxin is given in small amounts to humans, even though it is not an infection, it triggers a set of responses that are typical of what one would see with a true bacterial infection. This allows us to study the earliest changes in molecules and cells that are involved in some bacterial infections. This type of model is safe and has been used in humans for many years to understand the body s responses during infections. Normal volunteers 18 to 45 years of age may be eligible for this study. Candidates will have a history and physical examination, blood and urine tests, electrocardiogram (EKG) and chest X-ray. In addition, volunteers 40 to 45 years old will have an exercise stress test to screen for asymptomatic coronary artery disease. Participants will undergo one or more of the following procedures: Bronchoscopy, Bronchoalveolar Lavage, Bronchial Brushings, and Endobronchial Mucosal Biopsies: These techniques for examining lung function are used routinely in patient care and clinical research. The mouth and nasal and lung airways are numbed with an anesthetic. A bronchoscope (pencil-thin flexible tube) is then passed through the nose into the large airways of the lung. Cells and secretions from the airways are rinsed with salt water (bronchoalveolar lavage) and a flexible brush the size of a pencil tip is passed through the bronchoscope to scrape cells lining the airways. Lastly, pieces of tissue (the size of the ball of a ballpoint pen) lining the airways are removed for examination under the microscope. Intravenous Endotoxin: A small dose of endotoxin is injected into a vein. Blood samples are drawn at regular intervals for 8 hours after the injection and again after 1, 2, 3, 7 and 14 days to analyze the body s immune response to the bacteria in the blood. Instilled Endotoxin in the Lungs: A small amount (2 teaspoons) of salt water is squirted through a bronchoscope into a lobe of one lung, and then salt water containing a small dose of endotoxin is squirted into the other lung. Bronchial lavage, brushing, and biopsy (see above) are then done to study the response of the lung to the endotoxin. In addition, air is withdrawn through the bronchoscope to study air components from the lung that was instilled with salt water or endotoxin. Nitric Oxide Therapy: Endotoxin is instilled in a lung (see above) and then nitric oxide a colorless, odorless, tasteless gas mixed with room air in a concentration of 40 parts per million, is given through a cushioned mask placed over the mouth and nose. (Some participants will be given the nitric oxide mixture and others will breathe only room air through the mask to test the effects of the nitric oxide on the lung inflammation.) The mask will be worn continuously for 6 hours and removed before repeat bronchoscopy with lavage, brushing and biopsy. Some of the above procedures require placement of a catheter (thin plastic tube) in a wrist artery to monitor blood pressure from heartbeat to heartbeat and to collect blood samples. First, the skin is numbed with an anesthetic (lidocaine). A needle is then inserted into the artery, the catheter is slipped over the needle into the vessel, and the needle is removed.
NCT00001716 ↗ Effects of Nitric Oxide and Nitroglycerin in Patients With Sickle Cell Anemia Completed National Institutes of Health Clinical Center (CC) Phase 2 1998-07-01 Sickle cell anemia is the most common genetic disease affecting African-Americans. About 1 in every 1000 African-Americans has the disease and 1 in every 12 carry the genes that could be passed on to their children. People with sickle cell anemia have abnormal hemoglobin, the molecules responsible for carrying oxygen in the blood. The abnormal hemoglobin can cause damage to the red blood cells. The damaged red blood cell may then stick in the blood vessels and cause pain and injury to organs. Some of the complications caused by the sticking of blood cells are called acute pain crisis and acute chest syndrome (ACS). Nitric oxide (NO) is a gas that has been proposed as a possible therapy for the ACS complication of sickle cell anemia. Studies have shown that NO may favorably affect sickle cell hemoglobin molecules, thereby improving blood flow through small vessels. This study is designed to evaluate the effects of NO, when taken in combination with a drug called nitroglycerin on patients with sickle cell anemia and normal volunteers. The effects of these two drugs only last while the patient is receiving them. Researchers hope the information learned from this study will help to develop new therapies for sickle cell anemia.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for nitric oxide

Condition Name

Condition Name for nitric oxide
Intervention Trials
Asthma 65
Pulmonary Hypertension 46
Hypertension 34
Sickle Cell Disease 25
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Condition MeSH

Condition MeSH for nitric oxide
Intervention Trials
Hypertension 129
Hypertension, Pulmonary 80
Asthma 72
Diabetes Mellitus 40
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Clinical Trial Locations for nitric oxide

Trials by Country

Trials by Country for nitric oxide
Location Trials
Canada 95
United Kingdom 80
Germany 63
Egypt 57
Italy 51
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Trials by US State

Trials by US State for nitric oxide
Location Trials
California 81
Texas 61
Massachusetts 57
Maryland 56
New York 54
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Clinical Trial Progress for nitric oxide

Clinical Trial Phase

Clinical Trial Phase for nitric oxide
Clinical Trial Phase Trials
PHASE4 17
PHASE3 16
PHASE2 37
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Clinical Trial Status

Clinical Trial Status for nitric oxide
Clinical Trial Phase Trials
Completed 552
Recruiting 150
Terminated 99
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Clinical Trial Sponsors for nitric oxide

Sponsor Name

Sponsor Name for nitric oxide
Sponsor Trials
National Heart, Lung, and Blood Institute (NHLBI) 63
Mallinckrodt 44
Massachusetts General Hospital 20
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Sponsor Type

Sponsor Type for nitric oxide
Sponsor Trials
Other 1387
Industry 312
NIH 139
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Last updated: July 28, 2026

Nitric Oxide Clinical Trials Update, Market Analysis, and Exclusivity/Commercial Projections (Global)

Nitric oxide (NO) therapy is in the “mature specialty” category driven by neonatal respiratory indications, perioperative/pulmonary hypertension use, and hospital uptake. Current market dynamics are dominated by (1) neonatal intensive care unit (NICU) demand tied to surfactant era practice patterns, (2) payer scrutiny on device and delivery-system costs, and (3) limited competitive entry because the effective product is a tightly controlled, delivery-system dependent gas/therapy supply chain. Clinical development is less about “new molecular entities” and more about delivery method, dosing optimization, and narrower phenotypes (preterm infants, post-surgical pulmonary hypertension, and acute lung injury cohorts).

What clinical trials for nitric oxide are active and what do they test?

No “drug” exists in the conventional small-molecule sense; nitric oxide is administered via specialized delivery systems. Clinical trials therefore track both the clinical phenotype and the delivery approach.

Key trial themes in nitric oxide research

  • Neonatal pulmonary hypertension and hypoxic respiratory failure
    Focus areas include preterm infants, right ventricular dysfunction, and response biomarkers for escalation or discontinuation.
  • Perioperative and post-procedural pulmonary hypertension
    Studies examine intraoperative or immediate post-surgical hemodynamics, right-heart performance, and oxygenation outcomes.
  • Acute lung injury phenotypes
    Trials test whether NO benefits subgroups with specific ventilatory settings, severity windows, or inflammatory profiles.

How to read nitric oxide trial updates

  • Endpoints most often emphasize survival to discharge, oxygenation improvement, oxygen/ventilator weaning time, and hemodynamic metrics (pulmonary arterial pressure surrogates).
  • Trial designs typically use narrow inclusion and short time horizons because nitric oxide effects are rapid and safety monitoring is intensive.

What is the current market size for nitric oxide therapy and what drives demand?

Primary demand segments

  1. Neonatal respiratory care (NICU)
    NO use is tied to incidence of pulmonary hypertension in neonates and practice patterns for managing hypoxic respiratory failure and right-ventricular dysfunction.
  2. Hospital anesthesia and critical care Demand comes from OR and ICU protocols for acute pulmonary hypertension and postoperative pulmonary vascular resistance elevation.
  3. Pulmonary hypertension pathways NO is used as a bridging or acute-treatment modality rather than a chronic oral replacement in most settings.

Core commercial drivers

  • Hospital protocolization: NO therapy is adopted via clinical pathways in large hospital systems once outcomes and operational feasibility are established.
  • Device procurement and maintenance: utilization depends on whether delivery systems are available, maintained, and integrated into respiratory workflows.
  • Supply chain continuity: consistent gas supply and cartridge/bottle logistics affect ordering cadence.
  • Payer authorization: the therapy often triggers prior authorization in non-NICU indications, where evidence is more granular and use is payer-audited.

How will nitric oxide market growth project over the next 5 years?

Projection framework (what moves the curve)

  • Volume elasticity is limited because use is tied to acute inpatient settings and clinical criteria.
  • Pricing and reimbursement are the main levers: reimbursement rules, hospital contracting, and payor utilization management shape revenue more than unit demand.
  • Utilization shifts can occur if clinical guidelines move toward earlier or narrower use in specific neonatal subgroups.

Base/Downside/Upside directional outlook

  • Base case: low-to-mid single digit growth in revenue driven by incremental adoption in NICUs and critical care pathways, offset by cost controls.
  • Upside: higher growth if additional favorable trial evidence expands indication boundaries or supports earlier use in higher-likelihood phenotypes.
  • Downside: revenue compression if payers tighten utilization management, if hospitals rationalize device portfolios, or if new evidence reduces use in broader populations.

Which companies sell nitric oxide therapies and how do their products compete?

Competition is largely anchored in:

  • Delivery systems (the capital equipment and proprietary consumables)
  • Service coverage (training, installation, and in-hospital support)
  • Contracting scale with large hospital groups and GPOs

Competitive structure

  • Incumbent-driven market where hospital-installed systems create switching costs.
  • Limited direct generic substitution because switching typically requires compatible delivery infrastructure and protocol retraining.
  • Procurement influence: group purchasing organization (GPO) and health system contracting can determine winners in specific geographies.

What patents protect nitric oxide delivery systems and therapy indications?

Nitric oxide itself is not a protected invention, but the protectable IP is typically in:

  • Delivery apparatus and control methods
  • Cartridge/bottle formats and system integration
  • Manufacturing and quality control methods
  • Method-of-use claims tied to clinical phenotypes, dosing windows, and monitoring strategies

Patent estate reality for nitric oxide

  • Estates tend to be narrow in claim scope and highly system-specific.
  • Method-of-use claims, when present, often include clinical criteria and monitoring requirements rather than broad “use for pulmonary hypertension” language.

When does nitric oxide lose exclusivity and what is the expiration timeline?

Exclusivity is best assessed per commercial product plus device system rather than per “nitric oxide” concept. Without listing-specific Orange Book and patent numbers for the exact marketed nitric oxide products in scope, a defensible date-by-date exclusivity timeline cannot be generated.

What is the Orange Book status of nitric oxide therapies?

Orange Book status is typically assigned to specific NDA/BLA entries for nitric oxide therapies with defined strengths and delivery systems. A complete status review requires product-level listing data and linked patent numbers.

Are there Paragraph IV challenges or generic entry risks for nitric oxide products?

Entry risk is lower than with conventional small molecules because:

  • Device compatibility barriers raise substitution costs.
  • Hospital protocols require validated dosing and monitoring integration.
  • IP, where present, is frequently tied to delivery and system methods.

Paragraph IV challenges, if any, would be tied to specific NDA listings and identified listed patents. Without the product-level listing and patent identifiers, a legally accurate assessment cannot be produced.

What biosimilar risk exists for nitric oxide?

Nitric oxide is not a biologic product and does not have biosimilar pathways.

How does nitric oxide compare with alternatives for pulmonary hypertension in hospitals?

Common alternatives

  • Prostacyclin pathway therapies (IV, inhaled, or oral depending on setting)
  • Phosphodiesterase type 5 inhibitors
  • Endothelin receptor antagonists
  • Inhaled vasodilators used as acute pulmonary vasodilator agents

Where nitric oxide tends to win commercially

  • Rapid onset in acute settings
  • Established NICU and perioperative protocols
  • Short-term rescue or stabilization use where rapid hemodynamic modulation is needed

Where nitric oxide faces pressure

  • Cost-conscious formularies
  • Shifts toward alternative inhaled or IV therapies with broader outpatient or step-down pathways
  • Tight inpatient utilization management

What manufacturing or IP barriers affect switching to alternative nitric oxide supply?

Operational barriers

  • Delivery system dependence
  • Staff training and monitoring protocols
  • Safety and compliance checks tied to device workflows

IP barriers

  • System control and integration
  • Proprietary consumables or formats
  • Method-of-use and monitoring claims where enforced

What regulatory milestones matter for nitric oxide therapy updates?

Regulatory activity typically focuses on:

  • Label updates for neonatal subpopulations
  • Safety expansions or refined dosing and monitoring instructions
  • Updates tied to specific clinical trial outcomes

A complete regulatory timeline requires the exact NDA/BLA identifiers and FDA label history.


Key Takeaways

  • Nitric oxide therapy demand is concentrated in acute inpatient settings, especially NICUs, with hospital protocols and delivery-system availability shaping utilization more than molecular innovation.
  • Market growth is expected to be modest and contract/payer-driven, with revenue sensitivity to utilization management and hospital procurement cycles.
  • IP and exclusivity assessments must be product- and device-system specific because nitric oxide gas itself is not the protected invention; protectable assets usually sit in delivery methods, monitoring/control systems, and narrow method-of-use claims.
  • Switching risk is elevated by operational dependence on delivery systems, training, and protocol integration, which reduces the probability of rapid “generic-like” competition.

FAQs

1) What indications drive nitric oxide utilization in neonates vs adults?
Neonatal pulmonary hypertension/right-heart failure phenotypes and acute perioperative pulmonary hypertension drive most hospital use; adult use is more acute and bridging-oriented.

2) How do delivery systems influence nitric oxide adoption and cost?
Compatibility, monitoring integration, staff training, and service coverage drive adoption; device and consumable costs often determine formulary and contracting outcomes.

3) What endpoints determine whether a nitric oxide trial supports label expansion?
Survival, oxygenation/ventilator weaning, and hemodynamic improvement in defined severity windows with safety compliance.

4) Is nitric oxide likely to face biosimilar competition?
No. Nitric oxide is not a biologic product.

5) What alternatives most threaten nitric oxide in inpatient pulmonary hypertension protocols?
Clinicians often shift acute or bridging therapy to other inhaled vasodilators and IV therapies based on cost, availability, and ease of administration.


References (APA)

No sources were provided in the prompt, and no FDA/Orange Book/product-level listings or patent publication identifiers were included, so no verifiable citations can be generated.

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