Nesiritide

Class: Vasodilating Agents, Miscellaneous
VA Class: CV900
Chemical Name: Natriuretic factor-32 (human brain clone λhBNP57)
Molecular Formula: C₁₄₃H₂₄₄N₅₀O₄₂S₄
CAS Number: 124584-08-3
Brands: Natrecor

Medically reviewed by Drugs.com on Jan 21, 2022. Written by ASHP.

Introduction

Vasodilator; a biosynthetic (recombinant DNA origin) form of human B-type natriuretic peptide (BNP).

Uses for Nesiritide

Acute Decompensated Heart Failure

Treatment of acutely decompensated heart failure in patients with dyspnea at rest or with minimal activity.

Evidence demonstrating improved outcomes with IV vasodilator therapy in hospitalized patients with heart failure is lacking.

May be considered an adjunct to diuretic therapy for relief of dyspnea in patients hospitalized for acutely decompensated heart failure who do not have symptomatic hypotension.

FDA-approved labeling for treatment of dyspnea in patients with acutely decompensated heart failure based on clinical trials showing reductions in pulmonary capillary wedge pressure (PCWP) and improvement in dyspnea when assessed 3 hours after initiation of the IV infusion. A subsequent placebo-controlled trial in >7000 patients (ASCEND-HF) failed to show meaningful improvement in dyspnea at 6 or 24 hours or meaningful short-term reductions in rates of death or rehospitalization for heart failure when nesiritide was used in conjunction with standard therapy.

Some clinicians state that routine use cannot be recommended in the broad population of patients with acutely decompensated heart failure.

Use of intermittent, serial, or scheduled repetitive infusions in an outpatient setting for treatment of severe decompensated heart failure not recommended. A randomized, placebo-controlled trial failed to establish efficacy of serial outpatient nesiritide infusions for treatment of severe heart failure.

Manufacturer recommends strictly limiting use to patients with acutely decompensated heart failure whose manifestations warrant hospitalization or management in emergency department.

Manufacturer does not recommend use as replacement therapy for diuretics, to improve renal function, and/or to enhance diuresis. (See Renal Effects under Cautions.)

Nesiritide Dosage and Administration

General

• Administer only in settings where BP can be closely monitored and hypotension treated aggressively.

• Concomitant use of other cardiovascular agents including IV nitroglycerin, but excluding certain IV vasodilators (e.g., sodium nitroprusside, milrinone) and IV ACE inhibitors, was allowed in clinical studies.

Administration

Administer IV loading dose followed by continuous IV infusion.

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Reconstituted solutions contain no preservatives; solutions preferably should be prepared immediately before use.

Prime IV tubing with 5 mL of diluted nesiritide solution prior to connecting the tubing to the patient’s vascular acc...