Nesiritide (Natrecor) is a 32 amino acid recombinant human B type natriuretic peptide that is released by ventricular myocardium.

Indications of Nesiritide:

• Acutely decompensated heart failure (HF):

  • It is indicated for acutely decompensated heart failure with dyspnea at rest or with minimal activity

Nesiritide Dose in Adults:

Note: Natrecor is no longer available in the US.

Nesiritide (Natrecor) dose for the treatment of acute decompensated heart failure:

• Initial dose of intravenous 2 mcg/kg (bolus optional) followed by continuous infusion at 0.01 mcg/kg/minute.

Note: An increase beyond the initial infusion rate should be limited to selected patients and strict hemodynamic and renal function monitoring is required.

• Dose reduction or discontinuation should be considered in case of hypotension and the patient should be kept in Trendelenburg position and hydrated with intravenous fluids IV fluids, Trendelenburg position).
• A lower dose (reduce previous infusion dose by 30% and omit bolus) should be restarted once the patient is stabilized.

• Maximum dosing weight:

  • There are no specific guidelines on maximum dosing weight and clinical judgment should be used.

Nesiritide (Natrecor) Dose in Childrens

Nesiritide (Natrecor) dose in the treatment of decompensated Heart failure:

Note: Nesiritide is not recommended as first-line therapy and is given when other options have failed to lower central venous pressure.

• Continuous Intravenous infusion:

  • Initial bolus (optional):

    • 1 mcg/kg, followed by continuous infusion of 0.01 mcg/kg/minute; titrated by 0.005 mcg/kg/minute depending on clinical response
    • manufacturer's labeling recommends titrating not more frequently than every 3 hours in adults

  • usual reported dose range:

    • 0.005 to 0.02 mcg/kg/minute,maximum infusion rate: 0.03 mcg/kg/minute.

Nesiritide pregnancy Risk Factor: C

• Studies on animal reproduction did not show any adverse outcomes.
• It is not possible to make pregnancy recommendations based on human data.

Nesiritide use during breastfeeding:  

• It is not known if breast milk secretes nesiritide.
• Breastfeeding is not recommended for women suffering from cardiac disease.

Nesiritide (Natrecor) Dose adjustment in renal disease:

No dosage adjustment necessary. Use cautiously in patients with renal impairment and close monitoring of renal function should be done.

Nesiritide (Natrecor) Dose adjustment in liver disease:

No dosage adjustment provided in manufacturer’s labeling.

Common Side Effects of Nesiritide (Natrecor):

• Cardiovascular:

  • Hypotension

• Renal:

  • Increased Serum Creatinine
  • Renal Insufficiency

Uncommon Side Effects of Nesiritide (Natrecor):

• Central nervous system:

  • Headache

• Endocrine & metabolic:

  • Hypoglycemia

• Gastrointestinal:

  • Nausea

• Neuromuscular & skeletal:

  • Back pain

Contraindication to Nesiritide (Natrecor):

These include:

• Hypersensitivity to any component of the formulation or natriuretic Peptide
• Cardiogenic shock
• Hypotension persistant

Warnings and precautions

• Anaphylactic and hypersensitivity reactions

  • Negistiide can trigger severe anaphylactic and hypersensitivity reactions

• Hypotension

  • This can lead to prolonged hypotension, so it is important to be vigilant.

• Effects on the renal system:

  • Higher doses of it can cause azotemia or deranged renal function.

• Cardiovascular disease

  • Not recommended for use in significant valvular or constrictive pericarditis. Restrictive/obstructive Cardiomyopathy.

Nesiritide (United States: Not available): Drug Interaction

Monitoring parameters:

Monitoring is required for

• Renal function tests,
• urine output,
• BUN
• BP
• hemodynamic responses (including pulmonary capillary wedge pressure, RAP, CI),

How to administer Nesiritide (Natrecor)?

• The intravenous dose should not be given via a heparin-coated catheter (concurrent administration of heparin via a separate catheter is acceptable, per manufacturer).
• Prime intravenous tubing with 5 mL of infusion before connecting with a vascular access port and before starting the infusion.
• The drug should be given over 1 minute after withdrawing bolus from the infusion bag. The infusion should be started immediately after the bolus dose.

Mechanism of action of Nesiritide (Natrecor):

It acts by binding the guanylate-cyclase receptor on endothelial and vascular smooth muscles, resulting in increased intracellular cyclic Guanylate monophosphate, which then causes relaxation of smooth muscular cells.

The beginning of action:

• Pulmonary capillary pressure reduction: 15 min (60% of 3-hour effect achieved in this time period).

Peak effect:

• Within 1 hour

Duration:

• >60 minutes (up to several hours) for systolic blood pressure, hemodynamic effects persist longer than serum half-life would predict

Metabolism:

• Proteolytic cleavage by vascular endopeptidases and proteolysis following binding to the membrane-bound natriuretic peptide (NPR-C) and cellular internalization

Half-life elimination:

• Initial (distribution) 2 minutes
• Terminal:18 minutes

Excretion:

• Primarily eliminated by metabolism, also excreted in the urine.

Nesiritide Brand Names (International):

• Natrecor
• Bu Luo Na Tai

Nesiritide Brand Names in Pakistan:

No Brands Available in Pakistan.