Nesiritide (Intravenous)

Nesiritide is a sterile medication used to treat decompensated heart failure with dyspnea at minimal exertion (like eating, bathing, talking) or at rest.

Overview

This medication is administered into the body through an injection made into the veins. Continuous infusions help the patients to recover well. However, the drug may sometimes worsen the renal function or increases the chances of death within one month. A few side effects may be experienced especially after the first injection. The effects go away after a short while, and they tend to be severe to the patients aged 65 years and above. Nesiritide may interact with other injections like insulin - hence the patient should know the other drugs that the patient is currently taking.

Condition Treated

  • Chronic heart failure

Type Of Medicine

  • Human Btype Natriuretic Peptide

Side Effects

Nesiritide may sometimes cause unwanted effects along with the needed effects. Although not all of them occur, some may require immediate medical attention. The most common effect is low blood pressure which must be reported to the healthcare provider. Nesiritide may also cause chest pains and discomforts, bluish skin and clammy skin, breath shortness or breathing difficulties, slow, fast or irregular heartbeats.

Patients under Nesiritide medication have also reported having headache, dizziness, fainting, lightheadedness, unusual weakness and tiredness, vomiting and nausea. Some patients experience some pain at the point of injection, but this tends to go away after some time. However, it's advisable to check with your doctor if the spot becomes swollen and reddish for more than 48 hours.

Most of the effects caused by Nesiritide do not need medical help. The body continues adjusting to the drug hence they go away. Your doctor may also give you some advice on what to do to reduce the side impacts of this medication. However, inform your healthcare provider if you get severe abdominal and stomach pains, anxiety, confusion, increased cough, itchy skin, spitting blood after coughing, rose fever, crawling, burning or numbness on the surface.

Some patients have been reported to be sleepless while others get excess sleep. The effects may vary from one patient to another. Rare cases of patients getting leg cramps, shakiness and trembling, abnormal sweating and rashes have also been reported. The side effects are severe to the patients aged 65 years and above. Always check with your medical provider when you have any question or when the effects become persistent and bothersome.

Dosage

The usual recommended dose for Nesiritide is 2mcg/kg IV bolus followed by 0.01mcg/kg/min continuous infusion. Do not start this medication at a higher dose than the recommended one. The loading dose may, however, not apply to the patients with low systolic blood pressure or those under afterload reducers. Your healthcare provider may change the dosage depending on your condition.

  • The bolus volume is determined by this formula:
  • Bolus Volume (mL) = weight of the patient (kg) / 3
  • The infusion flow rate used to deliver 0.01mcg/kg/min dose is determined by this formula:
  • Infusion Flow Rate (mL/hr) = weight of the patient (kg) × 0.1
  • Before the medicine is administered to the body, it should be well prepared using the following steps.

Draw the Nesiritide from the infusion bag. Prime the infusion tubing with 5ml of the mixture before connecting to the vascular access port of the patient and before the bolus administration.

Reconstitute 1.5mg of Nesiritide by adding 5ml of the diluents got from a half-filled 250ml plastic infusion bag. After the vial reconstitution, each ml will be containing 0.32mg of Nesiritide. The following free from preservatives diluents can be used: 5% Dextrose Injection (D5W), USP; 5% Dextrose USP; 0.9% Sodium Chloride Injection, and 0.45% Sodium Chloride Injection, USP, 0.2% Sodium Chloride Injection or 5% Dextrose and, USP.

Avoid shaking the vial. Rock it gently to ensure that all its surfaces get in contact with diluents for a complete reconstitution. Use a clear and colorless solution for visibility.

Withdraw the Nesiritide reconstituted contents and add it to the 250ml IV bag. This will form a solution with a Nesiritide concentration of approximately 6mcg/ml. Invert the plastic IV bag for several times to make sure the solution mixes thoroughly.

Nesiritide does not contain any antimicrobial preservative hence you should make sure you use the solution within 24 hours. The parenteral products should be well inspected for any discoloration or particulate matter.

Nesiritide dosage may sometimes have limiting effects like hypotension. If hypotension occurs when you are not done with your Nesiritide dosage, you can reduce the dosage or discontinue the dosage. However, consult the doctor should be asked first. Other measures that support blood pressure may be initiated. A specified period will have to be observed before restarting the dosage again because the hypotension caused by Nesiritide can be prolonged. The restarted dose is reduced by approximately 30% without bolus administration until the patient stabilizes. Central hemodynamic monitoring should be used and the Nesiritide used should not exceed 003mcg/kg/min. It should also not be titrated more frequently than 4 hours.

In case you miss a dose, take it as soon as possible when you remember. However, make sure it is well spaced with the next treatment. Do not take it together with the second dose as that becomes double dosage and it may cause unwanted effects. If you miss a particular dose when you have a severe chronic disease, inform your healthcare provider first.

Warnings

Before you are given Nesiritide, let your doctor know if you are allergic to the drug or any of its ingredients. To be sure about this, you can ask the doctor to tell you the compounds used in the drug. Also, if you have another allergy, for example, food, other drugs or other substances, inform the doctor. If you get a Nesiritide injection and get signs like wheezing, shortness of breath, cough, or swelling in the throat and other body parts, seek immediate help as this could be signs of an allergic reaction.

Let your doctor know if you have:

  • Heart problems
  • Low blood pressure

An authorized medical practitioner should only administer Nesiritide. The medicine is not recommended to people with inappropriate vasodilating agents, low cardiac filling pressure, patients with pericardial tamponade, constrictive pericarditis, obstructive or restrictive cardiomyopathy and valvular stenosis. Also, patients with severe heart diseases whose renal function depends on rennin-angiotensin-aldosterone activity should be treated with caution.

Other drugs may reduce Nesiritide effectiveness. Keep a list of the medicines you are currently taking including the prescribed drugs, over the counter drugs, vitamin supplements, and herbal drugs. Share the list with your doctor. Also, avoid starting a new medication without consulting your healthcare provider.

If you are expectant or planning to have a baby soon, it's advisable to discuss this with your doctor. The doctor will outweigh the benefits and the risks of the drug while pregnant and advice accordingly. Many medications have been shown to be passed in human milk when breastfeeding; it's, therefore, important to let your healthcare provider know if you are breastfeeding.

While under Nesiritide medication, you will have to have regular blood pressure checkups. This is because this drug may cause hypotension. You will also have to be extremely careful while walking up and down in stairs after getting the medicine since it might cause dizziness.

Interactions

Some drugs should not be taken with others because they interact with the human body. These interactions can make some of the medicine to be less effective. Some reactions may be dangerous to the patient's body. Nesiritide is physically and chemically incompatible with the following injections. The drug should therefore not be co-administered with any of them.

  • Insulin
  • Heparin bumetanide
  • Ethacrynate sodium
  • Furosemide
  • Hydralazine

Sodium metabisulfite preservative is also incompatible with Nesiritide injection. Do not administer any injections that contain it in the same infusion path with Nesiritide. This medication binds to heparin hence it should not be applied through a heparin-coated catheter. If the injection must be done, a separate catheter should be used.

Storage

Store the vials at room temperature below 25C (77F). Keep it in the outer carton to prevent direct sunlight. Do not freeze. The reconstituted solution should be used within 24 hours. If that time elapses when it has not been used, discard it. The reconstituted vials can be stored at 2C to 25C (36F to 77F) up to 24 hours.

Summary

Nesiritide is a Human B- type Natriuretic Peptide that treats chronic heart failure. It is mostly used in patients who have shown no improvement after using other standard medications. The drug is administered by the body intravenously, and the dosage is calculated as per the patient's body weight. A few side effects may be experienced with the most common one been low blood pressure. The effects do not last for long especially when immediate medical attention is provided. Nesiritide may interact with other injections and reduce its effectiveness. The patient is required to inform the doctor if they are on different medications. This minimizes the cases of having severe effects and also ensures the drug is beneficial to the patient.