Nesiritide (Natrecor)
Overview
A recombinant form of human B-type natriuretic peptide (BNP), a 32-amino acid peptide naturally produced by ventricular cardiomyocytes in response to volume overload and wall stress. Nesiritide binds natriuretic peptide receptor A (NPR-A), activating guanylyl cyclase and increasing intracellular cGMP to produce venous, arterial, and coronary vasodilation, natriuresis, and suppression of the renin-angiotensin-aldosterone and sympathetic nervous systems.
Key Research Findings
FDA-approved in 2001 for acutely decompensated heart failure with dyspnea at rest. ASCEND-HF trial (2011) showed modest improvement in dyspnea but no reduction in mortality or rehospitalization, with trends toward worsening renal function and hypotension. Use has declined significantly in favor of other heart failure therapies. Remains available but relegated to second-line status by current guidelines.
Intravenous
FDA Approved
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