Nesiritide
Indications
Nesiritide is used for:
Chronic heart failure,
Acutely Decompensated CHF with Dyspnea at Rest
Adult Dose
Intravenous
Acutely decompensated heart failure
Adult: Initial loading dose: 2 mcg/kg by IV inj over 1 minute, followed immediately by a maintenance infusion of 0.01 mcg/kg/minute. Duration of treatment: At least 24 hr to >48 hr.
Child Dose
Renal Dose
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)
Contra Indications
Primary therapy for cardiogenic shock; systolic BP <90 mm Hg.
Precautions
Not recommended in patients with known or suspected low cardiac filling pressures or in whom vasodilating agents are inappropriate (e.g. significant valvular stenosis, restrictive or obstructive cardiomyopathy, constrictive pericarditis, pericardial tamponade). Not recommended in any other conditions in which cardiac output depends on venous return. Pregnancy, lactation, children. Monitor BP closely during admin. Stop or reduce dose and general supportive measures instituted if hypotension occurs during infusion.
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
Interactions
Increased risk of hypotension with drugs that may decrease BP.
Adverse Effects
Side effects of Nesiritide :
>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%)
Mechanism of Action
Nesiritide, a biosynthetic form of human B-type natriuretic peptide (BNP), is manufactured from E. coli using recombinant DNA technology. It is structurally and pharmacologically identical to endogenous BNP, which is the main natriuretic peptide responsible for normal fluid and sodium homeostasis maintenance in heart failure patients. Binding of endogenous BNP to the particulate guanylate cyclase receptor of vascular smooth muscle and endothelial cells increases cyclic guanosine-3', 5'-monophosphate (cGMP), which relaxes smooth muscle cells and causes arterial and venous dilation. It also produces dose-dependent reductions in pulmonary capillary wedge pressure and systemic arterial pressure in heart failure patients.