Nesiritide

Nesiritide (U.S. trade name Natrecor), a brain (B-type) natriuretic peptide, may help patients with decompensated congestive heart failure according to a randomized controlled trial. Natriuretic peptide causes diuresis, vasodilitation, and suppression of the renin-angiotensin system and sympathetic nervous system.

Nesiritide is considered adjunctive therapy for patients in severe heart failure, principally as a vasodilator, when neither nitroglycerine nor sodium nitroprusside provide sufficient benefit. Small studies suggest it may increase the risk of death, and further trials are underway. It has been suggested that intermittent intravenous infusion, as opposed to continuous microdrip administration, worsens the hazard.

A number of hospitals limit its use to critical care units, although others extend its use to telemetry units and emergency rooms. Patients receiving it do need close nursing observation; the hospitals limiting its use to ICUs may require monitoring with pulmonary artery catheterization (i.e., Swan-Ganz catheter).

It physically interacts with heparin and furosemide; heparinized intravenous administration sets must not be used with it, and it should not be administered through an IV access that has had a heparin lock.