Nesiritide

Nesiritide (Natrecor) is the recombinant form of the 32 amino acid human B-type natriuretic peptide, which is normally produced by the ventricular myocardium. Nesiritide works to facilitate cardiovascular fluid homeostasis through counterregulation of the renin-angiotensin-aldoesterone system, stimulating cyclic guanosine monophosphate, leading to smooth muscle cell relaxation.

Neseritide was believed initially to be beneficial for acute decompensated congestive heart failure. It received FDA approval for this purpose in 2001 after initial non-approval. In July 2011 the results of the largest study so far for nesiritide was published in The New England Journal of Medicine (NEJM); it showed that nesiritide was not associated with a change in mortality or re-hospitalizations.

Administration
Nesiritide is only administered intravenously, usually by bolus, followed by IV infusion. For most adults and the elderly, a normal dosage is 2 micrograms/kilogram followed by a continuous IV infusion of 0.01 mcg/kg/minute. This may be increased every three hours for a maximum of 0.03 mcg/kg/min.

Side effects
Common side effects include:
 * Low blood pressure (11% of patients)
 * Headache
 * Nausea
 * Slow heart rate

More rare side effects include:
 * Confusion
 * Paresthesia
 * Somnolence
 * Tremor