Nesiritide


Generic Medicine Info
Indications and Dosage
Intravenous
Acutely decompensated heart failure
Adult: Initial loading dose: 2 mcg/kg by IV inj over 1 minute, followed immediately by a maintenance infusion of 0.01 mcg/kg/minute. Duration of treatment: At least 24 hr to ≥48 hr.
Reconstitution
Reconstitute a vial containing 1.5 mg of nesiritide by adding 5 ml of preservative-free diluent removed from a pre-filled 250 ml plastic IV bag (e.g. 5% Dextrose, 0.9% Sodium Chloride, 5% Dextrose and 0.45% Sodium Chloride, or 5% Dextrose and 0.2% Sodium Chloride Inj). Do not shake the vial but swirl the vial gently to ensure complete dissolution. Completely withdraw the contents of the reconstituted vial and add to the 250 ml plastic IV bag, this will produce a solution of approx 6 mcg/ml of nesiritide. Invert the IV bag several times to ensure complete mixing of the solution.
Incompatibility
Physically and/or chemically incompatibility with heparin, insulin, sodium etacrynate, bumetanide, enalaprilat, hydralazine, furosemide and the preservative sodium metabisulfite; flush the catheter between admin of nesiritide and incompatible drugs. Do not give nesiritide through heparin-coated central catheters as it binds to heparin
Contraindications
Primary therapy for cardiogenic shock; systolic BP <90 mm Hg.
Special Precautions
Not recommended in patients with known or suspected low cardiac filling pressures or in whom vasodilating agents are inappropriate (e.g. significant valvular stenosis, restrictive or obstructive cardiomyopathy, constrictive pericarditis, pericardial tamponade). Not recommended in any other conditions in which cardiac output depends on venous return. Pregnancy, lactation, children. Monitor BP closely during admin. Stop or reduce dose and general supportive measures instituted if hypotension occurs during infusion.
Adverse Reactions
Hypotension, dizziness, headache, nausea, vomiting, abdominal pain, back pain, angina pectoris, insomnia, anxiety, renal function impairment.
IV/Parenteral: C
Overdosage
Symptoms: Excessive hypotension. Management: Reduce dose or discontinue drug. Treatment is supportive (e.g. IV fluids, changes in body position). Hypotension may persist for a few hr.
Drug Interactions
Increased risk of hypotension with drugs that may decrease BP.
Action
Description: Nesiritide, a biosynthetic form of human B-type natriuretic peptide (BNP), is manufactured from E. coli using recombinant DNA technology. It is structurally and pharmacologically identical to endogenous BNP, which is the main natriuretic peptide responsible for normal fluid and sodium homeostasis maintenance in heart failure patients. Binding of endogenous BNP to the particulate guanylate cyclase receptor of vascular smooth muscle and endothelial cells increases cyclic guanosine-3', 5'-monophosphate (cGMP), which relaxes smooth muscle cells and causes arterial and venous dilation. It also produces dose-dependent reductions in pulmonary capillary wedge pressure and systemic arterial pressure in heart failure patients.
Pharmacokinetics:
Excretion: Biphasic elimination; terminal elimination half life: 18 minutes. Removed from the circulation in 3 ways, in order of decreasing importance: Cellular uptake; proteolytic cleavage by endopeptidases and kidney excretion.
Storage
Store below 25°C, do not freeze and protect from light. Reconstituted vials may be stored at 2-25°C (36-77°F) for up to 24 hr.
MIMS Class
Disclaimer: This information is independently developed by MIMS based on Nesiritide from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by MIMS.com
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