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nesiritide (Natrecor)
Indications:
- acute heart failure & cardiogenic shock [8]
a) limit use to patients who present to hospital with acute heart failure & dyspnea at rest [4]
b) does not improve survival [5]
Contraindications:
1) scheduled repetitive use
2) to improve renal function
3) to enhance diuresis [4]
Dosage: IV, 1 vial/day for 2 days ($400/vial)
Adverse effects:
1) may be better tolerated than IV nitroglycerin
2) less likely than dobutamine to cause tachycardia or arrhythmias
3) may cause more prolonged hypotension than nitroglycerin
4) may be associated with increased risk of death [3]
5) may or may not be associated with renal failure [3,5]
Mechanism of action:
1) recombinant type-B natriuretic peptide
2) reduces systemic vascular resistance
3) improves dyspnea & fatigue in patients with CHF
Clinical trials:
- [7] nesiritide does not improve dyspnea, reduce rehospitalization or improve all-cause mortality in patients with acute heart failure [7]
Notes: Manufacturer: Scios
Specific
Nesiritide Parenteral
General
natriuretic hormone
recombinant protein; chimer
vasodilator agent
Properties
COMPARTMENT: extracellular compartment
MOTIF: cysteine residue {X}
MODIFICATION: cysteine residue {X2}
cysteine residue {X2}
MODIFICATION: cysteine residue {X}
References
- Prescriber's Letter 8(9):50 2001
- Journal Watch 25(11):89, 2005
Sackner-Bernstein JD, Kowalsi M, Fox M Aaronson, K
Short-term Risk of Death After Treatment with Nesiritide
for Decompensated Heart Failure: A pooled analysis of
randomized controlled trials.
JAMA 293(April 20): 1900, 2005
- FDA MedWatch
http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#natrecor
http://www.fda.gov/medwatch/safety/2005/safety05.htm#Natrecor2
- Journal Watch 25(15):124, 2005
http://www.natrecor.com/pdf/Braunwald_Panel_Release_&_Report.pdf
- Witteles RM et al,
Impact of nesritide on renal function in patients with acute
decompensated heart failure and pre-existing renal dysfunction:
A randomized, double-blind, placebo-controlled clinical trial.
J Am Coll Cardiol 2007, 50:1835
PMID: 17980284
- Silver MA and Yancy CW
Using homeostatic peptides in decompenstated heart failure:
A reasonable paradigm but a flawed practice?
J Am Coll Cardiol 2007, 50:1841
PMID: 17980249
- Yancy CW et al for the FUSION II Investigators
Safety and efficacy of outpatient nesiritide in patients with
advanced heart failure: Results of the Second Follow-Up Serial
Infusions of Nesiritide (FUSION II) trial.
Circ Heart Fail 2008, 1:9
PMID: 19808265
- Yancy CW et al for the FUSION II Investigators
The Second Follow-up Serial Infusions of Nesiritide
(FUSION II) trial for advanced heart failure: study rationale
and design.
Am Heart J. 2007 Apr;153(4):478-84.
PMID: 17383282
- O'Connor CM
Effect of Nesiritide in Patients with Acute Decompensated
Heart Failure
N Engl J Med 2011; 365:32-43
PMID: 21732835
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015