nesiritide
Brand: Natrecor
Prototype Drug
Drug Class: recombinant BNP / natriuretic peptide
Drug Family: vasodilator
Subclass: B-type natriuretic peptide (BNP) analog
Organ Systems: cardiovascular
Mechanism of Action
Recombinant human BNP; binds NPR-A receptors causing increased cGMP in vascular smooth muscle and renal tubules; venous and arterial vasodilation, natriuresis, inhibits RAAS and SNS.
natriuretic peptide receptor (NPR-A/B)
Indications
- acute decompensated heart failure (adjunct)
Contraindications
- cardiogenic shock
- SBP <90
Adverse Effects
Common
- hypotension
- headache
Serious
- severe hypotension
- worsening renal function
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | moderate |
| Metabolism | proteolytic degradation |
| Excretion | renal |
| Half-life | 18 minutes |
| Onset | immediate |
| Peak | 15 min |
| Duration | hours |
| Protein Binding | <0% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| ACE inhibitors | additive hypotension | moderate |
Nursing Considerations
- ASCEND-HF: nesiritide did not reduce HF rehospitalization or mortality
- May worsen renal function
- Monitor BP continuously
- Not recommended as routine therapy per current guidelines
Clinical Pearls
- ASCEND-HF trial: no mortality benefit, modest symptom improvement, worsened renal function — not recommended routinely
- Mechanism similar to sacubitril (raises natriuretic peptides) but exogenous replacement rather than enzyme inhibition
Safety Profile
Pregnancy avoid
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.