Classifications: atrial natriuretic peptide hormone; Therapeutic: cardiovascular; atrial natriuretic hormone (anh)
Pregnancy Category: C
1.5 mg vial
Nesiritide is a human B-type natriuretic peptide (hBNP), produced by recombinant DNA, which mimics the actions of human
atrial natriuretic hormone (ANH). ANH is secreted by the right atrium when atrial blood pressure increases. Nesiritide, like
ANH, inhibits antidiuretic hormone (ADH) by increasing urine sodium loss by the kidney and triggering the formation of a
large volume of dilute urine. Nesiritide binds to a cyclic nucleic acid, which results in smooth muscle cell relaxation.
Effective in causing smooth muscle relaxation. Nesiritide binds to a cyclic nucleic acid, which results in smooth muscle
cell relaxation. The drug also causes dilation of veins and arteries. It is effective in managing dyspnea at rest in patients
with acute congestive heart failure (CHF).
Acute treatment of decompensated CHF in patients who have dyspnea at rest or with minimal activity.
Hypersensitivity to nesiritide, patients with a systolic blood pressure <90 mm Hg, cardiogenic shock, patients with low
cardiac filling pressures, patients who should not receive vasodilators, such as those with significant valvular stenosis,
restrictive or obstructive cardiomyopathy, pericardial perfusion; constrictive pericarditis, pericardial tamponade; pregnancy
Lactation, concurrent administration of ACE inhibitors or vasodilators. Safety and efficacy in pediatric patients have not
Route & Dosage
|Acute Decompensated CHF
Adult: IV 2 mcg/kg bolus administered over 60 s, followed by a continuous infusion of 0.01 mcg/kg/min (0.1 mL/kg/h) (max: 0.03 mcg/kg/min).
Monitor blood pressure. If hypotension occurs, the dose should be reduced or discontinued. The infusion can subsequently
be restarted at a dose that is reduced by 30% (with no bolus administration) after stabilization of hemodynamics.
PREPARE: Direct and IV Infusion: Reconstitute one 1.5 mg vial by adding 5 mL of IV solution removed from a 250 mL bag of selected diluent (i.e., D5W, NS,
D5/0.45% NaCl, D5/0.2% NaCl). Rock the vial gently so that all surfaces, including the stopper, contact the diluent
ensuring complete reconstitution. Do not shake the vial. Add the entire contents of the vial to the 250 mL IV bag to yield
approximately 6 mcg/mL. Invert the bag several times to mix completely. Use within 24 h. Prime the IV tubing with 25 mL
prior to connecting to the vascular access port.
ADMINISTER: Direct: Bolus dose MUST BE withdrawn from the prepared infusion bag. Determine dose as follows: bolus volume (mL) = (0.33) x
(patient weight in kg). Give the bolus dose over 60 sec through an IV port in the tubing. IV Infusion: Infuse remainder of IV infusion immediately following the bolus dose. Determine the infusion rate as follows: flow rate
(mL/h) = (0.1) x (patient weight in kg).
INCOMPATIBILITIES Solution/additive and Y-site: Bumetanide, enalaprilat, ethacrynic acid, furosemide, heparin, hydralazine, insulin.
- Store at controlled room temperature at 20°25° C (68°77° F) or refrigerated.
Adverse Effects (≥1%)Body as a Whole:
Headache, back pain, catheter pain, fever, injection site pain, leg cramps. CNS: Insomnia
, dizziness, anxiety, confusion, paresthesia, somnolence, tremor. CV: Hypotension,
ventricular tachycardia, ventricular extrasystoles, angina, bradycardia, tachycardia, atrial fibrillation, AV node conduction
Abdominal pain, nausea, vomiting. Respiratory:
Cough, hemoptysis, apnea. Skin:
Sweating, pruritus, rash. Special Senses:
Renal failure in acutely decompensated heart failure patients.
Additive effects with antihypertensives
15 min. Duration:
>60 min depending on dose. Metabolism:
Proteolytic cleavage, proteolysis. Half-Life:
Assessment & Drug Effects
- Monitor hemodynamic parameters (e.g., BP, PCWP, HR, ECG) throughout therapy. Notify physician immediately if systolic BP
<90 mm Hg.
- Establish hypotension parameters prior to initiating therapy.
- Reduce the dose or withhold the drug if hypotension occurs during administration. Reinitiate therapy infusion only after
hypotension is corrected. Subsequent doses following a hypotensive episode are usually reduced by 30% and given without
a prior bolus dose.
- Lab tests: Baseline and periodic serum creatinine.