Cardiovascular & blood

Nesiritide

Recombinant human BNP, licensed in the US for acute decompensated heart failure, with neutral symptom benefit in large trials.

Moderate evidenceApproved drugAdd to compare

What it is

Nesiritide is a recombinant copy of human B-type natriuretic peptide, a 32-amino-acid hormone the heart releases when it is stretched. It is licensed in the US (Natrecor) for acutely decompensated heart failure with dyspnoea at rest; it does not hold an EU authorisation, and its role shrank after a large trial found no clear symptom benefit.

How it works

1
Binds natriuretic peptide receptor A on vascular smooth muscle and the kidney.
2
Raises intracellular cGMP, relaxing veins and arteries and lowering filling pressures.
3
Increases sodium and water excretion through the kidney.
4
Suppresses renin, aldosterone and sympathetic tone.
5
Its short half-life of about 18 minutes makes it titratable by infusion.

What it's studied for

Acute decompensated heart failure

Haemodynamic effects on pulmonary capillary wedge pressure

Comparisons against nitroglycerin and dobutamine

Renal function during acute heart failure (ROSE)

Reported and studied effects

Rapid fall in pulmonary capillary wedge pressure and improvement in dyspnoea in early studies
No significant improvement in dyspnoea or 30-day outcomes in ASCEND-HF
Hypotension is the most frequent adverse effect
Possible worsening renal function in some analyses

Research protocol notes

Research context only

Research context only - a hospital infusion. The labelled regimen is a 2 microgram per kilogram intravenous bolus optionally followed by an infusion of 0.01 micrograms per kilogram per minute, avoiding a bolus in hypotensive patients; ASCEND-HF randomised over 7,000 patients and measured dyspnoea at 6 and 24 hours plus 30-day death and rehospitalisation.

These figures are described so you can understand what researchers did. They are not a dose, a schedule, or a suggestion — and they are not a substitute for a doctor.

Possible side effects and contraindications

Safety profile

Possible side effects

Hypotension
Headache
Nausea
Ventricular arrhythmia in early reports
Raised creatinine
Injection-site reactions

Contraindications and cautions

Systolic blood pressure below 90 mmHg
Cardiogenic shock
Prior hypersensitivity
Inadequate cardiac filling pressures
Caution with other vasodilators

A side-effect list is never complete, and these are not the only situations that warrant caution. Anything unexpected, or anything you are unsure about, should be discussed with a doctor before use.

Evidence assessment

Moderate evidenceSeveral human trials, some inconsistencies

Several human trials, some inconsistencies

Small haemodynamic trials show clear pressure effects, but the large ASCEND-HF trial found no meaningful symptom or outcome benefit, leaving approval resting on surrogate endpoints.

References

References link to published literature, regulator pages or literature indexes. Where a link points to a search, it collects the peer-reviewed work on that molecule rather than a single study.

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