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Pharmacologic class: Human B-type natriuretic peptide

Therapeutic class: Vasodilator

Pregnancy risk category C


Binds to receptors on vascular smooth muscle and endothelial cells, causing smooth muscle relaxation and vasodilation. As a result, systemic and pulmonary pressures decrease and diuresis occurs.


Injection: 1.5 mg in single-use vials

Indications and dosages

Acutely decompensated heart failure in patients who have dyspnea at rest or with minimal activity

Adults: 2 mcg/kg I.V. bolus, followed by continuous I.V. infusion of 0.01 mcg/kg/minute


• Hypersensitivity to drug or its components

• Systolic pressure below 90 mm Hg

• Primary therapy for cardiogenic shock


Use cautiously in:

• restrictive or obstructive cardiomyopathy, constrictive pericarditis, pericardial tamponade, renal dysfunction, hypotension

• pregnant or breastfeeding patients.


Know that nesiritide is a high-alert drug.

• For I.V. use, prime tubing before connecting to patient. Withdraw bolus and infuse over 60 seconds into I.V. port of tubing. Follow immediately with constant infusion delivering 0.01 mcg/kg/minute.

• Know that drug should be mixed and infused in dextrose 5% in water, normal saline solution, or dextrose in half-normal saline solution.

Don't mix with other drug solutions. Always administer through separate line.

• Know that nesiritide therapy beyond 48 hours has not been studied.

Adverse reactions

CNS: dizziness, headache, insomnia, anxiety

CV: hypotension, angina pectoris, bradycardia, ventricular extrasystole, ventricular tachycardia

GI: nausea, vomiting, abdominal pain

Musculoskeletal: leg cramps, back pain

Respiratory: cough, hemoptysis, apnea

Other: injection site reactions


Drug-drug. Angiotensin-converting enzyme inhibitors, nitrates: increased hypotension

Bumetanide, enalaprilat, ethacrynate sodium, furosemide, heparin, hydralazine, insulin: physical and chemical incompatibility with nesiritide

Drug-diagnostic tests. Hematocrit, hemoglobin: decreased values

Patient monitoring

• Monitor vital signs and pulmonary artery wedge pressure continuously during and for several hours after infusion.

• Assess cardiovascular status closely.

Patient teaching

• Tell patient he'll be monitored closely during and for several hours after infusion.

• Inform patient that drug may cause serious adverse effects. Reassure him that he'll receive appropriate interventions to relieve symptoms.

• Instruct patient to report chest pain, dizziness, palpitations, and other uncomfortable symptoms.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.


a vasodilator used to treat acutely decompensated congestive heart failure.


A recombinant brain (B-type) natriuretic peptide given intraveinously to patients with acutely decompensated heart failure and dyspnoea at rest. Natrecor relaxes blood vessels, increases natriuresis and diuresis, and decreases neurohormones. 

Adverse effects
Hypotension, ventricular tachycardia, headache, nausea, back pain, decreased renal function. It has been linked to increased mortality or renal damage; it is to be used only on severely ill patients.


A commercial form of recombinant human natriuretic peptide that has been promoted in the USA. It was approved by the FDA for the treatment of acute, decompensated congestive heart failure. There were reports in mid-2005 of adverse effects on survival and kidney function.
References in periodicals archive ?
Nesiritide in congestive heart failure associated with acute coronary syndromes: a pilot study of safety and efficacy.
Acute study of clinical effectiveness of nesiritide in decompensated heart failure: nesiritide redux.
It includes milrinone, tolvaptan, nesiritide, levosimendan, tezosentan, low-dose dopamine, and ultrafiltration.
Long-term outcome of patients treated with prophylactic nesiritide for the prevention of acute kidney injury following cardiovascular surgery," Clinical Cardiology, vol.
Estas sugerencias se fortalecieron con la publicacion del discutido estudio CARRESS HF, (47) en donde se aleatorizaron 188 pacientes con sindrome cardio renal I a recibir dosis de diureticos escalonada, si habia necesidad de dobutamina, nitroglicerina, nesiritide o soporte ventricular asistido se podia utilizar en este grupo, comparado contra unicamente UF programado a 200ml/hr.
For these two patients, inotropic agents, nesiritide, diuretics, beta blockers, and vasodilators were used in combination.
Mentzer RM, Oz MC, Sladen RN, Graeve AH, Hebeler RF, Luber JM, et al; NAPA Investigators: Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: The NAPA Trial.
Safety and efficacy of outpatient nesiritide in patients with advanced heart failure: results of the second follow-up serial infusions of nesiritide (Fusion II) trial.
Nesiritide ve urodilatin partikul halindeki guanilat siklaz yoluyla etki gostererek vazodilator, natriuretik ve diuretik etki gosterirler (2).
La adecuada seleccion de los pacientes que requieren manejo inotropico es fundamental (14), los diureticos son de utilidad para el manejo de los sintomas de congestion; sin embargo, no disminuyen la mortalidad (15-16) y los vasodilatadores son de gran ayuda por su efecto sobre las resistencias perifericas que caracteristicamente se encuentran elevadas en el perfil hemodinamico de los pacientes con falla cardiaca, la nitroglicerina es el vasodilatador mas utilizado en nuestro medio, sin embargo existen otras alternativas como el nesiritide aunque se discute su modo de administracion ideal (dosis, administracion sin bolo) y su efecto adverso sobre la funcion renal (17-19).
Effect of nesiritide in combination with standard therapy on serum concentrations of natriuretic peptides in patients admitted for decompensated congestive heart failure.
IVCI medications identified by pharmacy as generally seen on the medical-surgical units were reviewed: amiodarone (Cordarone[R]), (Argatroban[R]), diltiazem, dobutamine, dopamine, eptifibatide (Integrilin[R]), furosemide (Lasix[R]), heparin, labetalol (Trandate[R]), lepirudin (Refludan[R]), nesiritide (Natrecor[R]), nitroglycerin, phenylephrine (Neo-Synephrine[R]), procainamide, tirofiban (Aggrastat[R]), and verapamil.