IntravenousAcutely decompensated heart failureAdult: 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.
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Reconstitute a vial containing 1.5 mg of nesiritide by adding 5 ml of preservative-free diluent removed from a pre-filled 250 ml plastic IV bag (e.g. 5% Dextrose, 0.9% Sodium Chloride, 5% Dextrose and 0.45% Sodium Chloride, or 5% Dextrose and 0.2% Sodium Chloride Inj). Do not shake the vial but swirl the vial gently to ensure complete dissolution. Completely withdraw the contents of the reconstituted vial and add to the 250 ml plastic IV bag, this will produce a solution of approx 6 mcg/ml of nesiritide. Invert the IV bag several times to ensure complete mixing of the solution.
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Physically and/or chemically incompatibility with heparin, insulin, sodium etacrynate, bumetanide, enalaprilat, hydralazine, furosemide and the preservative sodium metabisulfite; flush the catheter between admin of nesiritide and incompatible drugs. Do not give nesiritide through heparin-coated central catheters as it binds to heparin
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Primary therapy for cardiogenic shock; systolic BP <90 mm Hg.
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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.
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Hypotension, dizziness, headache, nausea, vomiting, abdominal pain, back pain, angina pectoris, insomnia, anxiety, renal function impairment.
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Symptoms: Excessive hypotension. Management: Reduce dose or discontinue drug. Treatment is supportive (e.g. IV fluids, changes in body position). Hypotension may persist for a few hr.
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Increased risk of hypotension with drugs that may decrease BP.
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Description: 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.
Pharmacokinetics:
Excretion: Biphasic elimination; terminal elimination half life: 18 minutes. Removed from the circulation in 3 ways, in order of decreasing importance: Cellular uptake; proteolytic cleavage by endopeptidases and kidney excretion.
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Store below 25°C, do not freeze and protect from light. Reconstituted vials may be stored at 2-25°C (36-77°F) for up to 24 hr.
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