Nesiritide Dosage

Usual Adult Dose for Congestive Heart Failure

Initial dose: 2 mcg/kg IV bolus, followed by 0.01 mcg/kg/min via continuous IV infusion; not to be titrated more frequently than every 3 hours to a maximum of 0.03 mcg/kg/min

Comments:

• This drug should not be initiated at a dose higher than the initial recommended dose.
• The loading dose may not be appropriate for those with systolic blood pressure less than 110 mmHg or for patients recently treated with afterload reducers.
• There is limited experience with administering this drug for longer than 96 hours; monitor blood pressure closely during administration.

Use: For the treatment of acutely decompensated heart failure in patients who have dyspnea at rest or with minimal activity

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Data not available

Dose Adjustments

Hypotension:

• Reduce dose or discontinue use if hypotension occurs during administration; initiate other measures to support blood pressure (e.g., IV fluids, changes in body position).
• Hypotension may be prolonged (up to hours) and a period of observation may be necessary before restarting.
• May be subsequently restarted at a dose that is reduced by 30% (without a bolus) once the patient is stabilized.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• For IV use only
• Following preparation of infusion bag, withdraw the bolus and administer over about 60 seconds via IV port; begin continuous infusion immediately following the bolus at a flow rate of 0.1 mL/kg/hr.
• Consult manufacturer product information for appropriate volume of bolus and infusion flow rate.
• Flush the catheter between administration of this drug and incompatible drugs.
• Do not administer through a central heparin-coated catheter.

Storage requirements:

• Vials: Store below 25C (77F); do not freeze; keep in outer carton to protect from light.
• Reconstituted solution: Use within 24 hours
• Reconstituted vials: May store at 2C to 25C (36F to 77F) for up to 24 hours.

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

IV compatibility:

• Compatible with 5% dextrose injection (D5W), 0.9% sodium chloride injection, 5% dextrose and 0.45% sodium chloride injection, and 5% dextrose and 0.2% sodium chloride injection.
• Incompatible with injectable formulations of heparin, insulin, ethacrynate sodium, bumetanide, enalaprilat, hydralazine, and furosemide; do not coadminister these drugs with nesiritide through same IV catheter.
• Do not administer injectable drugs that contain sodium metabisulfite in the same infusion line as nesiritide.

General:

• This drug has been shown to reduce pulmonary capillary wedge pressure and improve short term (3 hours) symptoms of dyspnea.

Monitoring:

• Cardiovascular: Monitor blood pressure closely during administration.
• Renal: Monitor serum creatinine both during and after therapy has completed.

Patient advice:

• Advise patients to notify their physician or healthcare professional if they have symptoms of hypotension.

See also:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer