PEPTIDESTAT
ApprovedClinical / approved drugIntravenousEvidence 2/5

Nesiritide

Also known as: Natrecor, BNP

Nesiritide binds the particulate guanylate cyclase natriuretic peptide receptor on vascular smooth muscle and endothelial cells, raising intracellular cGMP to produce vasodilation and reduced cardiac filling pressures.

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Nesiritide
Drug class
Recombinant human B-type natriuretic peptide (vasodilator)
Primary targets
Natriuretic peptide receptor-A (NPR-A), Particulate (membrane-bound) guanylate cyclase
Dose reference
Label reference only (discontinued; NOT a recommendation): 2 mcg/kg IV bolus followed by a 0.01 mcg/kg/min continuous infusion
Half-life
~18 minutes (terminal elimination; hemodynamic effects can persist several hours)
Developer / origin
Scios (later acquired by Johnson & Johnson)
Reference year
2001
Evidence score
2/5 - Approved on hemodynamics, neutral in pivotal outcome trial, discontinued

Approved uses

  • Acute decompensated heart failure (later discontinued)
Evidence 2/5

Approved on hemodynamics, neutral in pivotal outcome trial, discontinued

Nesiritide reliably lowers filling pressures and was FDA-approved in 2001 based on hemodynamic and symptom data (VMAC), but the definitive 7,141-patient ASCEND-HF trial found no benefit on death or 30-day rehospitalization and more hypotension. Earlier pooled analyses raised mortality and renal signals that were debated and not confirmed as net harm. Clinical use collapsed and the product was discontinued.

Mostly animal, ex vivo, cell, or indirect evidence.

Evidence basis

  • Pivotal ASCEND-HF RCT (NEJM 2011, n=7,141) showed no effect on death or rehospitalization and only a small non-significant dyspnea benefit
  • VMAC RCT (JAMA 2002) demonstrated hemodynamic improvement vs nitroglycerin/placebo, a surrogate endpoint
  • FDA Natrecor prescribing information documents mechanism, IV dosing and ~18-minute half-life
  • 2005 pooled analyses (JAMA, Circulation) raised contested short-term mortality and renal-function safety signals
  • Product subsequently discontinued; no current approved supply or labeled use

How to read this entry

Dose references and half-life values are pulled from trial protocols, labels, reviews, or published summaries where available. They are context for research and comparison, not a personal dosing recommendation.

Status matters: approved drugs have regulated indications; investigational compounds are still being studied; research-only peptides do not have established human dosing, safety, or efficacy for consumer use.

Nesiritide guides

Read the matching guide or adjacent research pages for more context.

Nesiritide Peptide: Recombinant BNP, ASCEND-HF and Why It Was DiscontinuedNesiritide is a recombinant human BNP peptide that was FDA-approved for acute heart failure, found neutral in ASCEND-HF, and later discontinued.Abaloparatide Peptide: Tymlos, PTHrP Analog Uses and Safety LimitsAbaloparatide is an FDA-approved PTHrP(1-34) analog peptide that builds bone in high-risk osteoporosis, backed by the ACTIVE and ATOM trials with clear duration and safety limits.Atosiban Peptide: Tractocile, Oxytocin Antagonist Tocolytic for Preterm LaborAtosiban is an EU-approved oxytocin and vasopressin receptor antagonist peptide used intravenously as a short-term tocolytic to delay preterm labor.Bivalirudin Peptide: Angiomax Direct Thrombin Inhibitor GuideBivalirudin is an FDA-approved, hirudin-derived bivalent direct thrombin inhibitor used as a short-acting intravenous anticoagulant during percutaneous coronary intervention.

Peptide calculators

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Research & educational purposes only

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