Nesiritide

Drug Information: Nesiritide

Detailed information regarding Nesiritide, a medication commonly used in clinical settings. Nesiritide is a recombinant form of human B-type natriuretic peptide (BNP), a naturally occurring hormone produced by the heart. It is primarily used in the treatment of acutely decompensated heart failure to alleviate symptoms like shortness of breath. Nesiritide works by promoting vasodilation, reducing preload and afterload on the heart, and ultimately improving cardiac function.

Category

Vasodilator (including nitrates)

Mechanism of Action

Nesiritide is a BNP analog, meaning it mimics the effects of endogenous B-type natriuretic peptide. BNP is released from the ventricles of the heart in response to volume expansion and increased wall stress. Nesiritide binds to guanylyl cyclase receptors on vascular smooth muscle and endothelial cells. This binding stimulates the intracellular production of cyclic guanosine monophosphate (cGMP). Increased cGMP levels in smooth muscle cells lead to vasodilation of both veins and arteries. Venodilation decreases preload (the volume of blood returning to the heart), while arteriolar dilation decreases afterload (the resistance against which the heart must pump). The overall effect is a reduction in cardiac workload and improved cardiac output. Furthermore, BNP, and therefore Nesiritide, promotes natriuresis (sodium excretion) and diuresis (fluid excretion) in the kidneys, contributing to a decrease in circulating blood volume and further reducing cardiac stress. This action is mediated through direct effects on the kidney and indirect effects via inhibition of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system.

Clinical Uses

Nesiritide’s clinical use primarily revolves around the treatment of acutely decompensated heart failure (ADHF). It is indicated for patients experiencing dyspnea (shortness of breath) at rest or with minimal exertion due to heart failure. The increase in cGMP levels caused by Nesiritide leads to vasodilation, which reduces both preload and afterload on the heart. This reduction in cardiac workload allows the heart to pump more efficiently, alleviating symptoms of heart failure such as shortness of breath and edema. While it effectively improves symptoms, clinical trials have not demonstrated a significant reduction in mortality or hospital readmission rates. Therefore, it is generally used as an adjunct therapy alongside other standard heart failure treatments, such as diuretics and ACE inhibitors, rather than as a primary treatment.

Dosage

Adults:
* Route of Administration: Intravenous (IV) infusion
* Typical Dose: A typical regimen involves an initial bolus dose of 2 mcg/kg administered over 1 minute, followed by a continuous infusion of 0.01 mcg/kg/min. The dose can be adjusted based on the patient’s clinical response and blood pressure, but caution should be exercised to avoid hypotension.

Pediatrics:
The safety and efficacy of nesiritide in pediatric patients have not been established. Use is generally not recommended.

Indications

* Acute Decompensated Heart Failure (ADHF) with dyspnea at rest or with minimal activity.

Contraindications

* Hypersensitivity to nesiritide or any of its components.
* Systolic blood pressure less than 90 mmHg.
* Cardiogenic shock.
* Patients for whom vasodilators are contraindicated, such as those with significant hypotensive risk.
* Use as primary therapy for cardiogenic shock.

FAQ

Q: What is Nesiritide used for?
A: Nesiritide is used to treat acutely decompensated heart failure, specifically to relieve symptoms like shortness of breath.

Q: How does Nesiritide work?
A: Nesiritide is a synthetic form of BNP that causes vasodilation, reducing the workload on the heart and improving its pumping efficiency. It also promotes sodium and fluid excretion by the kidneys.

Q: What are the common side effects of Nesiritide?
A: The most common side effect is hypotension (low blood pressure). Other potential side effects include headache, nausea, and dizziness.

Q: How is Nesiritide administered?
A: Nesiritide is administered intravenously (IV) as a bolus followed by a continuous infusion.

Q: Can Nesiritide be used in patients with low blood pressure?
A: No, Nesiritide is contraindicated in patients with systolic blood pressure less than 90 mmHg due to the risk of further hypotension.

Q: Does Nesiritide cure heart failure?
A: No, Nesiritide does not cure heart failure. It helps to alleviate symptoms of acute decompensation.

Q: Is Nesiritide a first-line treatment for heart failure?
A: No, it is usually used as an adjunct therapy alongside other standard heart failure treatments like diuretics and ACE inhibitors.

Q: Should Nesiritide be given to someone with a known allergy?
A: Nesiritide should not be administered to individuals who have a known hypersensitivity to it or any of its components.