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Recombinant human B-type (brain) natriuretic peptide
Mode of action
- vasodilatory, natriuretic and diuretic effects
- primarily mediated via natriuretic peptide receptor A on vascular smooth
muscle, endothelium, kidneys and adrenals
- no direct inotropic effect
- ± reduces aldosterone and inhibits plasma renin activity
Pharmacokinetics
- administration: IV infusion
- distribution
- distribution t1/2 ~2 mins
- mean volume of distribution at steady state 0.19 l/kg
- elimination by multiple routes:
- after binding to cell surface natriuretic peptide receptor C
nesiritide is internalized and degraded
- hydrolysis by endopeptidase
- renal filtration
- elimination t1/2 ~18 mins
- clearance proportional to body weight (~0.55 l/h/kg)
- dosage adjustment not required in patients with renal dysfunction
Clinical indications
- acute decompensated heart failure with dyspnoea on minimal exertion or at
rest
- reduces preload. Rapid reduction in pulmonary capillary wedge pressure
(faster than glyceryl trinitrate) and right atrial pressure
- reduces afterload resulting in increase in cardiac output
- diuresis & natriuresis
- 6 month mortality similar to patients treated with nitrate but lower
than those treated with dobutamine
- contraindicated in cardiogenic shock or in patients with systolic BP
<90 mmHg
Adverse effects
Cardiovascular
Similar incidence to patients treated with nitrate.
- hypotension
- usually resolves spontaneously or responds to fluid challenge of 250
ml or less
- duration of episode longer than hypotensive episodes associated with
glyceryl trinitrate
- not proarrhythmic
Non-cardiovascular
Less common than with glyceryl trinitrate
- general pain
- abdominal pain
- catheter-related pain
- headache
- nausea
Drug interactions
- does not interact with enalapril
- interactions with IV vasodilators (including IV ACE inhibitors) and other
cardiovascular drugs have not been formally studied
Dosage & administration
- bolus of 2 mcg/kg followed by infusion of 0.01 mcg/kg/min
- reduce dose/discontinue if hypotension occurs
- should only be used in pregancy if potential benefit to mother outweighs
potential risk to fetus
- administer with caution to breastfeeding mothers
Further reading
Keating GM, Goa KL. Nesiritide. A review of its use in acute
decompensated heart failure. Drugs, 2003; 63(1):47-70
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