Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 1.5mg/vial
Acutely Decompensated CHF with Dyspnea at Rest
2 mcg/kg IV bolus over 1 minute, THEN
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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)
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
Warnings
Contraindications
Persistent systolic blood pressure <100 mm Hg prior to therapy because of increased risk of symptomatic hypotension
Hypersensitivity to drug or excipients
Cardiogenic shock
Cautions
Therapy may decrease renal function as judged by increases in serum creatinine; monitor serum creatinine both during and after therapy completed; monitor serum creatinine until values have stabilized; in patients with severe heart failure whose renal function may depend on activity of renin-angiotensin-aldosterone system, therapy may be associated with azotemia
Hypersensitivity
- Serious hypersensitivity/allergic reactions following administration of therapy reported; these reactions are more likely to occur in individuals with history of sensitivity to recombinant peptides
- Before therapy is instituted, careful inquiry should be made to determine whether patient has had a previous hypersensitivity reaction to other recombinant peptides; if an allergic reaction occurs, discontinue drug
- Some serious hypersensitivity/allergic reactions may require treatment with epinephrine, oxygen, IV fluids, antihistamines, corticosteroids, pressor amines and airway management, as clinically indicated
Hypotension
- Therapy may cause hypotension; administer therapy only in settings where blood pressure can be monitored closely and hypotension aggressively treated; reduce dose of or discontinue therapy in patients who develop hypotension; avoid administration in patients suspected of having, or known to have low cardiac filling pressures
- Not recommended for patients for whom vasodilating agents are not appropriate, such as patients with significant valvular stenosis, restrictive or obstructive cardiomyopathy, constrictive pericarditis, pericardial tamponade, or other conditions in which cardiac output is dependent upon venous return or for patients suspected to have low cardiac filling pressures
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.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
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
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