Generic Name

Nesiritide

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Classification

FDA Approved Indications

• Acute management of decompensated heart failure with dyspnea

Mechanism of Action

Nesiritide is a recombinant form of human B-type natriuretic peptide (BNP). It binds to guanylyl cyclase receptors on vascular smooth muscle and coronary arteries, stimulating the production of cyclic GMP, leading to vasodilation, natriuresis, and diuresis, which reduces preload and afterload, alleviating symptoms of heart failure.

Dosage and Administration

Adult: Initial dose of 2 micrograms/kg IV bolus over 60 seconds, followed by a continuous infusion of 0.01 micrograms/kg/min. Adjust based on clinical response.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; consider renal function and blood pressure.

Renal Impairment: Monitor closely; dosage adjustment may be necessary.

Hepatic Impairment: Limited data, use with caution.

Pharmacokinetics

Absorption: Administered intravenously, so immediate IV absorption.

Distribution: Distributes rapidly in the plasma; volume of distribution approximately 20-30 L.

Metabolism: Cleaved by neutral endopeptidases and rapidly cleared from circulation.

Excretion: Primarily renal clearance of breakdown products.

Half Life: About 18 minutes.

Contraindications

• Hypersensitivity to nesiritide or any component of the formulation.
• Concurrent use of other intravenous vasodilators unless medically indicated.

Precautions

• Use with caution in patients with systolic blood pressure <100 mm Hg; monitor blood pressure closely.
• Monitor for hypotension, renal impairment, and arrhythmias.

Adverse Reactions - Common

• Hypotension (Common)
• Nausea (Less common)

Adverse Reactions - Serious

• Significant hypotension leading to shock (Uncommon)
• Renal impairment or failure (Uncommon)
• Arrhythmias (Less common)

Drug-Drug Interactions

• Other vasodilators may have additive effects

Drug-Food Interactions

• No significant interactions known

Drug-Herb Interactions

• Limited data

Nursing Implications

Patient/Family Teaching

• Report symptoms of hypotension, dizziness, chest pain, or worsening renal function.
• Do not discontinue medication abruptly.
• Follow-up appointments for renal and cardiovascular assessment.

Special Considerations

Black Box Warnings:

• Potential for hypotension leading to renal impairment or shock.

Genetic Factors: Not specifically impacted by genetic factors.

Lab Test Interference: May alter serum levels of renal function markers; interpret labs with caution.

Overdose Management

Signs/Symptoms: Hypotension, dizziness, syncope, renal impairment.

Treatment: Stop infusion, provide supportive care, and treat hypotension with fluids or vasopressors as needed.

Storage and Handling

Storage: Store vials at 2-8°C, in a refrigerator.

Stability: Stable for 24 hours at room temperature after reconstitution, but best stored refrigerated.