Nesiritide
Pronunciation: (neh-SIR-i-tide).
- Generic name
- nesiritide
- Brand names
- Nesitide, Carditide, Natrecor
- Drug class
- Vasodilator (Recombinant B-type natriuretic peptide)
Availability and supply rules vary by country
Trade names by country:
Australia: · Full directory
What nesiritide is and how it works
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how nesiritide works
Nesiritide is a recombinant form of human B-type natriuretic peptide (BNP). It binds to guanylate cyclase receptors on vascular smooth muscle and endothelial cells, increasing intracellular cyclic GMP. This leads to vasodilation of arteries and veins, reducing preload and afterload, and promoting natriuresis and diuresis. The net effect is decreased cardiac filling pressures and improved cardiac output in acute heart failure. (2)
What nesiritide is used for
Acutely decompensated heart failure with dyspnea (breathlessness) at rest or with minimal activity
Given in a hospital setting under close monitoring; not intended for chronic/repeated outpatient use. (2)
Before taking nesiritide
Do not take / not appropriate for
- persistent systolic blood pressure <100 mmHg prior to therapy, cardiogenic shock, and hypersensitivity to nesiritide. (Contraindication) (2)
Tell your clinician about
(2)How to take nesiritide
- General Instructions: Nesiritide is administered as an intravenous infusion in a hospital setting. It is not intended for self-administration. There is limited experience giving it for longer than 96 hours.. Adult Dosing: The recommended initial dose is a 2 mcg/kg IV bolus given over 60 seconds, followed by a continuous infusion at 0.01 mcg/kg/min; the team will not start above this recommended dose. The bolus may not be appropriate if blood pressure is already low (systolic under about 110 mmHg) or if another blood-pressure-lowering (afterload-reducing) medicine was recently given. Dose may be adjusted based on clinical response and blood pressure.. Pediatric Dosing: Safety and efficacy in pediatric patients have not been established. Use in children is not recommended.. Administration: Given by a healthcare professional through a vein (IV). The infusion rate may be adjusted depending on patient response and blood pressure.. When To Stop: The infusion should be stopped if severe hypotension or other serious adverse effects occur, or when symptoms improve as determined by the healthcare provider.. Storage: Store unopened vials at 2°C to 25°C (36°F to 77°F). Protect from light. Once reconstituted, use within 24 hours.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (2)
Missed dose
As nesiritide is administered in a hospital setting by healthcare professionals, missed doses are unlikely. If a dose is missed, the healthcare provider will determine the appropriate course of action.
Overdose
Symptoms of overdose may include severe hypotension and related complications. If overdose is suspected, stop the infusion immediately and provide supportive care, including intravenous fluids and vasopressors if needed. Emergency medical attention is required. (2)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Low blood pressure (hypotension)
Incidence: Most common reaction (>=3%) in FDA clinical trials
Headache
Incidence: Common (>=3%) in FDA clinical trials
Nausea
Incidence: Common (>=3%) in FDA clinical trials
Back pain
Incidence: Common (>=3%) in FDA clinical trials
Serious warnings
Low blood pressure (hypotension) is a well-documented risk — serious
Symptoms: Low blood pressure (hypotension) is a well-documented risk: symptomatic hypotension occurred in about 7 in 100 treated patients (vs. about 4 in 100 with placebo) in clinical trials, and lasted an average of a little over 2 hours when it happened. Because of this, nesiritide is only given where blood pressure can be monitored closely and low blood pressure treated right away.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
May cause severe hypotension — serious
Symptoms: May cause severe hypotension; monitor blood pressure closely. Use with caution in patients with renal impairment. Not recommended for chronic heart failure or as a substitute for diuretics. May worsen renal function in some patients — serum creatinine is checked both during and after treatment until it stabilizes. Risk of allergic reactions, including anaphylaxis.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
Contraindications recorded in the clinician database — serious
Symptoms: Contraindications recorded in the clinician database: Contraindications include persistent systolic blood pressure <100 mmHg prior to therapy, cardiogenic shock, and hypersensitivity to nesiritide. Use with caution in patients with renal impairment, hypotension, or those at risk for volume depletion. Monitor closely for worsening renal function and symptomatic hypotension.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Recorded interactions | Nesiritide may interact with other medications that lower blood pressure, such as ACE inhibitors, ARBs, nitrates, and diuretics, increasing the risk of hypotension. Inform your healthcare provider of all medications you are taking. | |
| IV-line (Y-site) incompatibilities: heparin, insulin, ethacrynate sodium, bumetanide, enalaprilat, hydralazine, furosemide | These should not be given through the same IV line/catheter as nesiritide; the infusion team manages line compatibility. Heparin-coated catheters are also avoided with this medicine. | (2) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Animal studies at about 100 times the recommended human dose showed no toxicity to the fetus. Separately, pregnant women with heart failure themselves face a higher risk of preterm birth, related to the underlying heart failure rather than specifically to nesiritide. Use during pregnancy should be an individualized decision made with the treating team. (2)
Breastfeeding
There is no human data on whether nesiritide passes into breast milk. Discuss the risks and benefits of breastfeeding during treatment with the healthcare team. (2)
Children
Frequency: Not applicable. Weight Based: Not recommended for pediatric use. Max Daily Dose: Not applicable. Max Single Dose: Not applicable. Age Restrictions: Safety not established in children (2)
Renal_impairment
No specific renal or hepatic dose-adjustment schedule is defined in the label. Because nesiritide can reduce kidney function (raising serum creatinine), kidney function is monitored both during and after treatment, continuing until values stabilize, in all patients — with extra caution in those who already have renal impairment. (2)
Hepatic_impairment
No specific renal or hepatic dose-adjustment schedule is defined in the label. Because nesiritide can reduce kidney function (raising serum creatinine), kidney function is monitored both during and after treatment, continuing until values stabilize, in all patients — with extra caution in those who already have renal impairment. (2)
Monitoring
(2)Storage
Unopened vials are stored below 25C (77F), not frozen, and kept in the outer carton to protect from light. Once reconstituted, the solution may be stored at 2-25C (36-77F) and must be used within 24 hours. Patients do not store or handle this medication themselves — it is prepared and given by hospital staff.
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General
Indication: Acutely decompensated heart failure with dyspnea at rest or minimal activity
Dose summary: 2 mcg/kg IV bolus over 60 seconds, then continuous infusion at 0.01 mcg/kg/min (do not initiate above this recommended dose). Bolus caution if SBP <110 mmHg or recent afterload-reducer use. Limited experience beyond 96 hours of infusion.
Renal context: No specific renal dose-adjustment schedule is defined; nesiritide can reduce renal function, so serum creatinine is monitored during and after therapy until it stabilizes, with added caution in pre-existing renal impairment. (2)
Frequently asked questions
What is nesiritide used for?
Nesiritide is used to treat acute decompensated heart failure in patients who have shortness of breath at rest or with minimal activity. It helps reduce symptoms by relaxing blood vessels and lowering the workload on the heart.
How is nesiritide given?
Nesiritide is administered as an intravenous infusion in a hospital setting by healthcare professionals. It is not taken by mouth or self-administered.
What are the most common side effects of nesiritide?
The most common side effects are low blood pressure, headache, nausea, dizziness, and back pain.
Can nesiritide be used in children?
Nesiritide is not recommended for use in children, as safety and efficacy have not been established in pediatric patients.
What should I do if I feel dizzy or faint while receiving nesiritide?
Inform your healthcare provider immediately if you feel dizzy or faint. These may be signs of low blood pressure, and your infusion may need to be adjusted or stopped.
Are there any medicines I should avoid while receiving nesiritide?
Avoid other medications that lower blood pressure unless approved by your doctor, as they may increase the risk of hypotension.
Is nesiritide safe for pregnant or breastfeeding women?
There is limited data on the use of nesiritide in pregnancy and breastfeeding. It should only be used if clearly needed and prescribed by your doctor.
What happens if I take too much Nesiritide?
Taking too much Nesiritide can lead to severe hypotension (low blood pressure), which may manifest as dizziness, fainting, or extreme weakness. If an overdose is suspected, it is critical to seek immediate emergency medical attention. Healthcare providers will monitor vital signs and provide supportive care to manage symptoms.
Can I drink alcohol while taking Nesiritide?
Drinking alcohol while taking Nesiritide is generally not recommended. Both Nesiritide and alcohol can cause vasodilation and lower blood pressure. Combining them can significantly increase the risk of severe hypotension, dizziness, and fainting. Always consult your healthcare provider regarding alcohol consumption with any medication.
Is Nesiritide safe during pregnancy?
The safety of Nesiritide during pregnancy has not been definitively established. It is categorized as a medication where the risks to the fetus are unknown. Therefore, it is crucial to consult your doctor if you are pregnant, planning to become pregnant, or breastfeeding before using Nesiritide to discuss the potential risks and benefits.
What is the mechanism of action of nesiritide?
Nesiritide is a recombinant form of human B-type natriuretic peptide (BNP). It binds to guanylate cyclase receptors on vascular smooth muscle and endothelial cells, increasing intracellular cyclic GMP. This leads to vasodilation of arteries and veins, reducing preload and afterload, and promoting natriuresis and diuresis. The net effect is decreased cardiac filling pressures and improved cardiac output in acute heart failure. (2)
What is the generic name of Nesiritide?
The generic name is nesiritide. It is sold under brand names including Nesitide, Carditide, Natrecor.
What class of drug is nesiritide?
Nesiritide is classed as: Vasodilator (Recombinant B-type natriuretic peptide).
References
- Nesiritide — MedGuideGlobal clinician-authored medicine recordMedGuideGlobal internal medicine record · Not country-specific · accessed 2026-08-06 · source 1
- NATRECOR (nesiritide) — prescribing informationU.S. Food and Drug Administration · United States · dated 2019 · accessed 2026-08-06 · source 2
Brand names by country
Single-ingredient nesiritide names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.