nesiritide (Rx)

Brand and Other Names:Natrecor
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1.5mg/vial

Acutely Decompensated CHF with Dyspnea at Rest

2 mcg/kg IV bolus over 1 minute, THEN

0.01 mcg/kg/min IV infusion  

If hypotension, discontinue until stabilized, then restart at 30% lower dose

Limited data available for use longer than 48 hours

Renal Impairment

Use caution; monitor renal function closely

Hepatic Impairment

Dose adjustment not necessary

Safety and efficacy not established

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Interactions

Interaction Checker

and nesiritide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (12)

                • benazepril

                  nesiritide, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • bretylium

                  nesiritide, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

                • captopril

                  nesiritide, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • enalapril

                  nesiritide, enalapril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • fosinopril

                  nesiritide, fosinopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • lisinopril

                  nesiritide, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • maraviroc

                  maraviroc, nesiritide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

                • moexipril

                  nesiritide, moexipril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • perindopril

                  nesiritide, perindopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • quinapril

                  nesiritide, quinapril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • ramipril

                  nesiritide, ramipril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                • trandolapril

                  nesiritide, trandolapril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

                Minor (0)

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                  Adverse Effects

                  >10%

                  Hypotension (4-35% )

                  Serum creatinine raised (17-28%)

                  1-10%

                  Nausea (4-13% )

                  Ventricular tachycardia (3-10% )

                  Headache (7-9% )

                  Dizziness (3-6% )

                  Insomnia (2- 6% )

                  Back pain (4%)

                  Ventricular premature beats (3-4% )

                  Anxiety (3%)

                  Angina (2%)

                  Atrial fibrillation (1% or greater )

                  Atrioventricular node (1% or greater )

                  Bradycardia (1%)

                  Somnolence (1%)

                  Tremor (1%)

                  Postmarketing Reports

                  Hypersensitivity reaction

                  Extravasation

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                  Warnings

                  Contraindications

                  Atrial/ventricular arrhythmias, constrictive pericarditis, restrictive or obstructive cardiomyopathy, pericardial tamponade, significant valvular stenosis, suspected low cardiac filling pressures

                  Hypersensitivity

                  Primary treatment for patients with cardiogenic shock

                  Persistent systolic BP <100 mm Hg

                  Cautions

                  Hypotenstion effects may be additive when using other agents that cause hypotension

                  Potential for nephrotoxicity

                  Use only in hospital setting

                  Caution in patients with renal impairment

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                  Pregnancy & Lactation

                  Pregnancy

                  There are no data to assess a drug associated risk of major birth defects, miscarriage, or adverse maternal fetal outcomes with therapy use in pregnant women; in animal reproduction studies, intravenous administration of to pregnant rabbits, during the period of organogenesis at 100 times the maximum recommended human dose (MRHD) did not result in any toxicities to the rabbits or their developing fetuses

                  Pregnant women with heart failure are at increased risk for preterm birth; heart failure may worsen with pregnancy and lead to maternal death or stillbirth

                  Lactation

                  There are no data on the presence of nesiritide in human or animal breast milk, or regarding the effect on the breastfed child, or on milk production

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Mechanism of Action

                  Recombinant human B-type natriuretic peptide; increases cGMP in vascular smooth muscle resulting in vasodilation, reduce pulmonary capillary wedge pressure (PCWP)

                  No effect on cardiac contractility

                  Pharmacokinetics

                  Duration: Several hours (for systolic blood pressure); hemodynamic effect may persist longer its half-life

                  Onset: 15 min (PCWP reduction);

                  Peak Plasma Time: 90-120 min

                  Vd: 0.19 L/kg

                  Metabolism: By neutral endopeptidases in proximal tubule brush border in the kidney

                  Excretion: Urine; metabolism

                  Half-Life: 18-23 min

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                  Administration

                  IV Preparation

                  Reconstitute 1.5 mg vial with 5 mL of diluent removed from a premixed plastic IV bag; mix gently; add contents of vial to a 250 mL IV bag. Allowable diluents include D5W, NS, D5/0.5NS. Makes ~6 mcg/mL

                  No preservatives - use within 24 hr. May be stored in fridge or room temp for 24 hr

                  IV Administration

                  Bolus

                  • Must be drawn from prepared infusion bag
                  • Prime IV tube with 5 mL infusion soln prior to bolus or infusion
                  • Withdraw bolus amount from infusion bag & administer over 1 min thru IV port

                  Infusion

                  • Immediately following bous, start infusion at 0.01 mcg/kg/min (0.1 mL/kg/hr)
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                  Images

                  No images available for this drug.
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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

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                  The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                  2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                  3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                  4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  NC NOT COVERED – Drugs that are not covered by the plan.
                  Code Definition
                  PA Prior Authorization
                  Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                  QL Quantity Limits
                  Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                  ST Step Therapy
                  Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                  OR Other Restrictions
                  Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.