Version May 2024
Note: Natrecor is no longer available in the United States.
Acute decompensated heart failure: IV: Initial: 2 mcg/kg (bolus optional); followed by continuous infusion at 0.01 mcg/kg/minute. Note: Should not be initiated at a dosage higher than initial recommended dose. There is limited experience with increasing the dose >0.01 mcg/kg/minute; in one trial, a limited number of patients received higher doses that were increased no faster than every 3 hours by 0.005 mcg/kg/minute (preceded by a bolus of 1 mcg/kg), up to a maximum of 0.03 mcg/kg/minute. Increases beyond the initial infusion rate should be limited to selected patients and accompanied by close hemodynamic and renal function monitoring.
Patients experiencing hypotension during the infusion: Infusion dose should be reduced or discontinued. Other measures to support blood pressure should be initiated (eg, IV fluids, Trendelenburg position). Hypotension may be prolonged (up to hours); once patient is stabilized, may attempt to restart at a lower dose (reduce previous infusion dose by 30% and omit bolus).
Maximum dosing weight: According to the manufacturer, the PRECEDENT Trial capped dosing weight at 160 kg and the VMAC Trial capped dosing weight at 175 kg. There are no specific guidelines on maximum dosing weight and clinical judgment should be used.
No dosage adjustment necessary. Use cautiously in patients with renal impairment or those patients who rely on the renin-angiotensin-aldosterone system for renal perfusion. Monitor renal function closely.
No dosage adjustment provided in manufacturer’s labeling.
Refer to adult dosing. Older individuals may be more sensitive to the effect of nesiritide than younger patients.
(For additional information see "Nesiritide (United States: Not available): Pediatric drug information")
Note: Natrecor is no longer available in the US.
Decompensated heart failure: Limited data available: Note: Nesiritide is not recommended for first-line therapy; may be considered when other treatment options have failed to lower central venous pressure (CVP) (ISHLT [Kirk 2014]): Infants, Children, and Adolescents:
Continuous IV infusion: Initial bolus (optional): 1 mcg/kg, followed by continuous infusion of 0.01 mcg/kg/minute; titrate by 0.005 mcg/kg/minute based on clinical response; manufacturer's labeling recommends titrating not more frequently than every 3 hours in adults; usual reported dose range: 0.005 to 0.02 mcg/kg/minute; maximum infusion rate: 0.03 mcg/kg/minute (Jefferies 2007; Mahle 2005). Dosing is based on a retrospective study and an observational study. The retrospective study included 30 pediatric patients (age: median: 4.6 months, range: 5 days to 16.7 years) with heart failure and worsening symptoms despite receiving conventional therapy (eg, inotropic and diuretic therapy). Most patients (80%) received a bolus dose of 1 mcg/kg and all patients received a continuous infusion of 0.005 to 0.02 mcg/kg/minute. Fluid balance and urine output significantly increased after 24 hours of treatment. Minimal effects on blood pressure were reported during infusion; however, one patient required discontinuation due to hypotension (Mahle 2005). Similar results were reported in the observational study of 63 patients (age: 11.97 ± 4.76 years; range: 0.01 to 20.5 years); patients were treated with an initial infusion rate of 0.01 mcg/kg/minute (without bolus dose); if necessary based on clinical response, rate was titrated by 0.005 mcg/kg/minute to a maximum rate of 0.03 mcg/kg/minute. Urine output improved on days 1 and 3 of therapy and only two patients required discontinuation due to hypotension (Jefferies 2007). If hypotension occurs during nesiritide administration, consider reducing dose or discontinuing infusion; if necessary, other measures to support blood pressure should be initiated.
No dosage adjustment necessary. Use cautiously in patients with renal impairment or those patients who rely on the renin-angiotensin-aldosterone system for renal perfusion. Monitor renal function closely.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Incidences of adverse reactions include unapproved dosing regimens as well as combination therapy data.
>10%:
Cardiovascular: Hypotension (4% to 12%)
Renal: Increased serum creatinine (28% with >0.5 mg/dL above baseline; 5% with 50% greater serum creatinine levels than at baseline), renal insufficiency (>25% decrease in glomerular filtration rate: 31%)
1% to 10%:
Central nervous system: Headache (7%)
Endocrine & metabolic: Hypoglycemia (≥2%)
Gastrointestinal: Nausea (3%)
Neuromuscular & skeletal: Back pain (3%)
<1%, postmarketing and/or case reports: Extravasation, hypersensitivity reactions, pruritus, skin rash
Hypersensitivity to natriuretic peptide or any component of the formulation; cardiogenic shock (when used as primary therapy); hypotension (persistent systolic blood pressure <100 mm Hg) prior to therapy
Concerns related to adverse effects:
• Anaphylactic/hypersensitivity reactions: Serious anaphylactic or hypersensitivity reactions may occur following administration; obtain careful history and use caution in patients with previous hypersensitivity to other recombinant peptides; nesiritide prepared through recombinant technology using E. coli.
• Hypotension: May cause hypotension; administer in clinical situations when blood pressure may be closely monitored. Effects may be additive with other agents capable of causing hypotension. Hypotensive effects may last for several hours.
• Renal effects: May be associated with development of azotemia; use caution in patients with renal impairment or in patients where renal perfusion is dependent on renin-angiotensin-aldosterone system (eg, severe heart failure); avoid initiation at doses higher than recommended; increases in serum creatinine may occur at an elevated rate.
Disease-related concerns:
• Cardiovascular disease: Should not be used in patients with low cardiac filling pressures, or in patients with conditions which depend on venous return including significant valvular stenosis, restrictive or obstructive cardiomyopathy, constrictive pericarditis, and pericardial tamponade.
• Renal impairment: Use with caution in patients with renal impairment.
Other warnings/precautions:
• Prolonged infusions: Use caution with prolonged infusions; limited experience with infusions >96 hours.
Natrecor is no longer available in the US.
May be product dependent
Solution (reconstituted) (Natrecor Intravenous)
1.5 mg (per each): $1,270.21
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
IV: Do not administer through a heparin-coated catheter (concurrent administration of heparin via a separate catheter is acceptable, per manufacturer).
Prime IV tubing with 5 mL of infusion prior to connection with vascular access port and prior to administering bolus or starting the infusion. Withdraw bolus from the prepared infusion bag and administer over 60 seconds. Begin infusion immediately following administration of the bolus.
IV: Administer as a continuous infusion with the use of an infusion pump. Do not administer through a heparin-coated catheter (concurrent administration of heparin via a separate catheter is acceptable, per manufacturer).
Prime IV tubing prior to connection with vascular access port and prior to administering bolus or starting the infusion. In adults, the bolus is administered over 1 minute; bolus administration rate not reported in pediatric or neonatal trials; slower infusion may be warranted based on hypotension risk; use caution. Begin continuous IV infusion immediately following administration of the bolus.
IV infusion: 1.5 mg in 250 mL (concentration: 6 mcg/mL) of D5W or NS
Acutely decompensated heart failure (HF): Treatment of acutely decompensated heart failure (HF) with dyspnea at rest or with minimal activity
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
Natrecor [Canada, Argentina, Venezuela] may be confused with Nitrocor brand name for nitroglycerin [Italy, Russia, Venezuela]
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification
Amisulpride (Oral): May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy
Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy
Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy
Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Adverse events were not observed in an animal reproduction study.
Data in humans are inadequate to make recommendations for use in pregnancy (ESC [Regitz-Zagrosek 2018]).
It is not known if nesiritide is present in breast milk.
Breastfeeding is not recommended for women with heart failure due to the high metabolic demands of lactation and breastfeeding (ESC [Regitz-Zagrosek 2018]).
Blood pressure, hemodynamic responses (PCWP, RAP, CI), BUN, creatinine; urine output; consult individual institutional policies and procedures
Binds to guanylate cyclase receptor on vascular smooth muscle and endothelial cells, increasing intracellular cyclic GMP, resulting in smooth muscle cell relaxation. Has been shown to produce dose-dependent reductions in pulmonary capillary wedge pressure (PCWP) and systemic arterial pressure.
Onset of action: PCWP reduction: 15 minutes (60% of 3-hour effect achieved within this time period)
Peak effect: Within 1 hour
Duration: >60 minutes (up to several hours) for systolic blood pressure; hemodynamic effects persist longer than serum half-life would predict
Distribution: Vss: 0.19 L/kg
Metabolism: Proteolytic cleavage by vascular endopeptidases and proteolysis following binding to the membrane bound natriuretic peptide (NPR-C) and cellular internalization
Half-life elimination: Initial (distribution) ~2 minutes; Terminal: ~18 minutes
Excretion: Primarily eliminated by metabolism; also excreted in the urine
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
