This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Elkayam, U. Articles by Singh, H. Search for Related Content PubMed PubMed Citation Articles by Elkayam, U. Articles by Singh, H. Social Bookmarking                         What's this?

Nesiritide: A New Drug for the Treatment of Decompensated Heart Failure

Mohammed Waseem Akhter, MD

Priya Tummala, MD

Salman Khan, MD

Harpreet Singh, MD

Division of Cardiology, University of Southern California School of Medicine, 1200 N. State Street, Los Angeles, CA

Nesiritide, a recombinant human B-type natriuretic peptide, is the first in a new drug class for the treatment of decompensated heart failure. The drug binds to receptors in the vasculature, kidney, adrenal gland, and brain, and overcomes resistance to endogenous BNP present in patients with CHF. Nesiritide administration leads to a rapid and balanced vasodilatory effect, which results in a significant decrease in right and left ventricular filling pressures and systemic vascular resistance and at the same time in an increase in stroke volume and cardiac output without a change in heart rate. These early hemodynamic changes result in a rapid improvement in symptoms of heart failure. In addition, nesiritide lowers aldosterone, catecholamines, and endothelin-1 levels and its effect on the kidney leads to an increased natriuresis and diuresis without effect on serum potassium or renal function. Prior to its approval for clinical use, nesiritide was studied in 10 different clinical trials involving 941 patients with moderate and severe CHF, including elderly patients, patients with both systolic and diastolic dysfunction, and patients with arrhythmias, renal insufficiency, and acute ischemic syndrome. In comparative studies with available vasoactive therapies frequently used for treatment of patients with decompensated heart failure, nesiritide was proven comparable in efficacy to inotropic drugs such as dobutamine, but superior in safety. In a recent study, nesiritide was found to be more effective and better tolerated than the vasodilator, nitroglycerin. The most common side effects expected with the use of nesiritide are headaches and decrease in blood pressure. At the recommended dose of nesiritide, headache was reported during the first 24 hours of treatment in 8% of patients and symptomatic hypotension in 4% of patients, compared to 20% and 5% in nitroglycerin-treated patients.

Key Words: nesiritide • decompensated heart failure • natriuretic peptides

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 7, No. 3, 181-194 (2002)
DOI: 10.1177/107424840200700308


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				L. B. Yap, D. Mukerjee, P. M. Timms, H. Ashrafian, and J. G. Coghlan Natriuretic Peptides, Respiratory Disease, and the Right Heart Chest, October 1, 2004; 126(4): 1330 - 1336. [Abstract] [Full Text] [PDF]