MASSACHUSETTS GENERAL HOSPITAL

Department of Pharmacy

Department of Nursing

Generic Name :           Nesiritide

Trade Name :              Natrecor®

Action :                        Brain naturetic peptide which acts as an arterial & venous vasodilator, increasing water and sodium excretion, lowering pulmonary capillary wedge pressure\& systemic arterial pressures and increasing cardiac output.

Indications:                  The use of this drug is restricted to patients who are on the Heart Transplant List and have failed standard therapy.  Use requires approval by an attending physician in the Heart Failure Group

Administration Guidelines:

Usual Dosage Range and Route:

Loading dose : IV bolus: 2mcg/kg administered over 60 seconds

Maintenance : Continuous infusion at an initial dose of 0.01mcg/kg/min. BP and HR should be measured and assessed frequently

Dose Titration

• The fixed dose of 0.01 mcg/kg/min is sufficient in most patients.
• If clinically appropriate, titrate up by increments of 0.005mcg/kg/min, (preceded by a bolus of 1mcg/kg) no more frequently than every 3 hours, up to a maximum dose of 0.03 mcg/kg/min as tolerated.

Standard Concentrations:

• 1.5mg/250mL (6mcg/mL)

EW Standard Concentration

• 1.5mg/250mL (6mcg/mL)

Special Considerations:

·          Onset within 15 minutes post bolus dose

·          Peak effect seen in 30–60 minutes

·          Duration of activity is approximately 1.5 hours

Precautions and Side Effects:

·          Headache (8% in clinical trials)

·          Symptomatic hypotension (4% in clinical trials)

·          Nausea 4%

·          Abdominal pain 1% Nesiritide should not be administered through heparin coated catheters.

·          Concomitant administration of a heparin infusion through a separate catheter is acceptable.

·          No fluid other than nesiritide, D5W, or saline solution should be administered through the same line as nesiritide.

rev: 04/08