Dosing and uses of Natrecor (nesiritide)
Adult dosage forms and strengths
injectable solution
- 1.5mg/vial
Acutely Decompensated CHF with Dyspnea at Rest
2 mcg/kg IV bolus over 1 minute, THEn
0.01 mcg/kg/min IV infusion
If hypotension, discontinue until stabilized, then restart at 30% lower dose
Limited data available for use longer than 48 hours
Pediatric dosage forms and strengths
Safety and efficacy not established
Natrecor (nesiritide) adverse (side) effects
>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%)
Postmarketing Reports
Hypersensitivity reaction
Death, Increased risk
Risk of azotemia in pts with renal impairment
Warnings
Contraindications
Atrial/ventricular arrhythmias, constrictive pericarditis, restrictive or obstructive cardiomyopathy, pericardial tamponade, significant valvular stenosis, suspected low cardiac filling pressures
Hypersensitivity
Primary Tx for pts with cardiogenic shock
Systolic BP <90
Cautions
Hypotenstion
Potential for nephrotoxicity
Use only in hospital setting
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if excreted into breast milk, use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Natrecor (nesiritide)
Half-Life: 18-23 min
Duration
Hemodynamic effect: IV bolus: 2-4 hr, IV infusion: 0.5-2 hr
Diuretic effect: IV infusion: 60 min
Onset
Hemodynamic effect: initial effect: 15-30 min, max effect: 60 min
Diuretic effect: 30-60 min
Other Information
Peak Plasma Time: 90-120 min
Vd: 0.19 L/kg
Metabolism: by neutral endopeptidases in proximal tubule brush border in the kidney
Excretion: unknown
Mechanism of action
Recombinant human B-type natriuretic peptide; incr cGMP in vascular smooth muscle resulting in vasodilation, reduce pulmonary capillary wedge pressure (PCWP)
No effect on cardiac contractility
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)
