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Clinical Pharmacy Specialist, Cardiothoracic Surgery, Harper University Hospital, Detroit Medical Center, Detroit, MI
Clinical Pharmacy Specialist, Cardiology, Harper University Hospital, Detroit Medical Center; Adjunct Assistant Professor, College of Pharmacy, University of Michigan, Ann Arbor, MI; Adjunct Assistant Professor, College of Pharmacy and Allied Health Professions, Wayne State University, Detroit
Coordinator, Clinical Pharmacy Services, Harper University Hospital, Detroit Medical Center
Reprints: Aungkana Vichiendilokkul MS PharmD, Harper University Hospital, Detroit Medical Center, 3990 John R Rd., Detroit, MI 48201-2097, FAX 313/745-1628, E-mail avichien{at}dmc.org
OBJECTIVE: To review preclinical and clinical information related to nesiritide, a recombinant form of B-type natriuretic peptide approved for treatment of acutely decompensated heart failure.
DATA SOURCES: Primary and review articles were identified by MEDLINE search (1966–May 2002) using the key words natriuretic peptide and heart failure, and through secondary sources. Natrecor's document submitted for the Food and Drug Administration (FDA) New Drug Application were obtained from the FDA Web site.
STUDY SELECTION/DATA EXTRACTION: Peer-reviewed articles and abstracts of randomized clinical trials in humans were included in this review.
DATA SYNTHESIS: Nesiritide has beneficial actions for treatment of heart failure, including arterial and venous dilatation, enhanced sodium and urinary excretion, and suppression of the renin–angiotensin–aldosterone and sympathetic nervous systems. It has been shown to improve hemodynamic parameters, primarily pulmonary capillary wedge pressure, as well as clinical symptoms in patients with acutely decompensated heart failure. Nesiritide produced more rapid hemodynamic improvement and caused significantly fewer adverse effects than intravenous nitroglycerin. The incidence of hypotension, the most common adverse effect, was comparable between nesiritide and nitroglycerin. Additionally, nesiritide is associated with a lower incidence of arrhythmias than dobutamine and has a neutral effect on mortality.
CONCLUSIONS: Nesiritide offers an alternative for management of acutely decompensated heart failure. It is considered an option for patients who do not respond to other vasodilators, inotropes, or diuretics and for those at high risk of arrhythmias. Further pharmacoeconomic investigations for nesiritide are warranted.
Key Words: heart failure, natriuretic peptides, nesiritide
Published Online, January 13, 2003. www.theannals.com, DOI
THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-005-H01
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