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

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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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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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.