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.
This page is a structured profile. Narrative evidence, dosing context and FAQs live on the research guide — not duplicated here as a second full article.
- 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)
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
Key references
- New England Journal of MedicineEffect of Nesiritide in Patients with Acute Decompensated Heart Failure (ASCEND-HF). N Engl J Med. 2011;365:32-43
- JAMA / PubMedIntravenous nesiritide vs nitroglycerin for decompensated congestive heart failure (VMAC). JAMA. 2002;287:1531-40
- U.S. FDANatrecor (nesiritide) for intravenous infusion, FDA prescribing information (2009)
- CirculationRisk of worsening renal function with nesiritide. Circulation. 2005;111:1487-1491
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.
Peptide calculators
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