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Nesiritide Side Effects

In Summary

Commonly reported side effects of nesiritide include: hypotension, symptomatic hypotension, asymptomatic hypotension, and increased serum creatinine. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to nesiritide: intravenous powder for solution

As well as its needed effects, nesiritide may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking nesiritide, check with your doctor immediately:

More common:
  • Low blood pressure
Less common:
  • Bluish lips or skin
  • chest pain, tightness, or discomfort
  • cool, clammy skin
  • difficulty in breathing or shortness of breath
  • dizziness
  • fainting
  • lightheadedness
  • fast, slow, or irregular heartbeat
  • unusual tiredness or weakness

Minor Side Effects

Some nesiritide side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Headache
Less common:
  • Abdominal or stomach pain
  • anxiety
  • back pain
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings on the skin
  • change in vision
  • confusion
  • coughing or spitting up blood
  • fever
  • increased cough
  • itching skin
  • leg cramps
  • nausea
  • pain or irritation at the injection site
  • pale skin, unusual bleeding or bruising
  • rash
  • sleepiness or unusual drowsiness
  • sleeplessness
  • sweating
  • trembling or shakiness
  • vomiting

For Healthcare Professionals

Applies to nesiritide: intravenous powder for injection


Cardiovascular side effects have included hypotension (11% to 35%), ventricular tachycardia (3% to 10%), ventricular extrasystoles (3% to 4%), angina pectoris (2% to 6%), and bradycardia (1% to 5%). Other side effects occurring in at least 1% of patients have included tachycardia, atrial fibrillation, and AV node conduction abnormalities.[Ref]

The mean duration of symptomatic hypotension was 2.2 hours with nesiritide, compared to 0.7 hours with nitroglycerin.

Nesiritide was associated with a lower incidence of severe ventricular arrhythmias than dobutamine: sustained ventricular tachycardia (1% vs 7%), nonsustained ventricular tachycardia (11% vs 17%), cardiac arrest (0 vs 5%).[Ref]

Nervous system

Nervous system side effects have included headache (up to 4.2%), insomnia (2% to 6%), dizziness (3% to 6%), and anxiety (2% to 3%). Other side effects occurring in at least 1% of patients have included confusion, paresthesia, somnolence, tremor, and fever.[Ref]


Gastrointestinal side effects have included dry mouth (up to 20.1%), constipation (up to 9.6%), upper abdominal pain (up to 1.5%), constipation (up to 1.4%), dyspepsia (up to 1.2%), and flatulence (up to 1.2%).[Ref]


Local reactions reported in at least 1% of patients have included catheter pain and injection site reactions.[Ref]


Respiratory side effects reported in at least 1% of patients have included increased cough and apnea.[Ref]


Renal side effects reported have included increases in serum creatinine of greater than 0.5 mg/dL above baseline (17% in patients receiving 0.015 mcg/kg/min, 19% in patients receiving 0.03 mcg/kg/min, 28% in patients receiving a 2 mcg/kg bolus followed by 0.020 mcg/kg/min).[Ref]


Other side effects have included anticholinergic central nervous system (CNS) effects including dizziness, confusion, hallucinations and somnolence. Patients should be monitored for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose. If a patient experiences anticholinergic CNS effects, dose reduction or drug discontinuation should be considered.[Ref]


Ocular side effects have included amblyopia (up to 1%) and dry eyes (up to 1.2%).[Ref]


Dermatologic side effects have included pruritus and rash in at least 1% of patients. Angioedema of the face, lips, tongue, and/or larynx has been reported postmarketing.[Ref]


Endocrine side effects have included sweating in at least 1% of patients.[Ref]


Musculoskeletal side effects have included back pain (1% to 4%) and leg cramps (at least 1%).[Ref]


Hematologic side effects have included anemia in at least 1% of patients.[Ref]


Metabolic side effects have included hypokalemia (3%) and hypomagnesemia (1% to 3%) in a trial with 103 CHF patients.[Ref]


Hypersensitivity side effects including postmarketing reports of hypersensitivity reactions have been reported.[Ref]


Genitourinary side effects have included urinary retention (up to 1.2%).


1. Burger AJ, Elkayam U, Neibaur MT, Haught H, Ghali J, Horton DP, Aronson D "Comparison of the occurrence of ventricular arrhythmias in patients with acutely decompensated congestive heart failure receivin dobutamine versus nesiritide therapy." Am J Cardiol 88 (2001): 35-9

2. "Product Information. Natrecore (nesiritide)" Scios Inc, Sunnyvale, CA.

It is possible that some side effects of nesiritide may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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