Adult Dosing
Treatment of acutely decompensated congestive heart failure
- Initial: 2 mcg/kg IV bolus over 60 seconds followed by continuous infusion at a rate of 0.01 mcg/kg/min
- Adjustments: Infusion rate may be increased by 0.005 mcg/kg/min, no more frequently than every 3 hrs. Prior to increasing the rate, a bolus dose of 1 mcg/kg should be administered
- Max: 0.03 mcg/kg/min
- Discontinue or decrease dose if symptomatic hypotension occurs. Restart by reducing dose by 30% once patient is stabilized
Reconstitution: Reconstitute 1.5 mg vial by adding 5 mL of a preservative-free diluent (e.g., 5% dextrose and 0.2 or 0.45% sodium chloride, 0.9% sodium chloride) taken from a prefilled 250-mL infusion bag. The final contents of the vial are then added back to the original 250-mL infusion bag for dilution, to yield a final nesiritide concentration of approximately 6 mcg/mL
Pediatric Dosing
- Safety and effectiveness in pediatric patients has not been established
[Outline]
- Nesiritide may cause hypotension; concomitant use of oral ACE inhibitors may increase risk of hypertension. Therapy must be administered only in settings where blood pressure can be monitored closely and hypotension is treated. Consider tapering of dose or discontinue if hypotension develops. Therapy is not recommended in patients suspected of having, or known to have, low cardiac filling pressures
- Avoid nesiritide when vasodilators are inappropriate such as in patients with significant valvular stenosis, restrictive/obstructive cardiomyopathy, constrictive pericarditis, pericardial tamponade, conditions where cardiac output is dependent on venous return or for patients suspected to have low cardiac filling pressures)
- Therapy may decrease renal function. Evaluate serum creatinine both during and after therapy. Azotemia may occur in patients with severe heart failure
- Serious hypersensitivity/allergic reactions have been reported in patients receiving nesiritide. Discontinue the therapy if allergic reactions occur
Cautions: Use cautiously in
- Valvular stenosis
- Restrictive or obstructive cardiomyopathy
- Constrictive pericarditis
- Pericardial tamponade
- Low cardiac filling pressures
- Patients with a blood pressure <100 mm Hg at baseline
- Hypotensive states
Pregnancy Category:C
Breastfeeding: It is not known whether nesiritide is excreted in breast milk. Manufacturer advises caution
