Nesiritide

Direct vasodilators
Direct vasodilators

Recombinant human B-type natriuretic peptide (BNP) given intravenously in acute heart failure to dilate vessels. Hypotension limits it; now little used.

Updated Nov 12, 2026

Also called: Recombinant human BNP

Quick facts

Group: Direct vasodilators
Target: Natriuretic peptide receptor A (NPR-A)
Used for: Acutely decompensated heart failure
Key effects: Hypotension · Headache · Nausea
Monitor: Urine output · Symptoms of congestion
ATC: C01DX19

No doses: the clinician sets them by the current guideline.

Mechanism of action

Natriuretic peptide receptor A (NPR-A)Nesiritide

The figure shows the extracellular hormone-binding part of rat NPR-A holding a fragment of human ANP; BNP, which nesiritide copies, binds the same receptor.

Target in 3D: Natriuretic peptide receptor A (NPR-A). PDB structure 7BRK (RCSB PDB, public domain). View the structure at RCSB PDB

Nesiritide has the same amino-acid sequence as human BNP, which the ventricles release when they are stretched. It binds natriuretic peptide receptor A on vascular smooth muscle and other cells; activating this receptor raises cGMP inside the cell. Veins and arteries relax, filling pressure (pulmonary capillary wedge pressure) and blood pressure fall, and there is some natriuresis and inhibition of renin-angiotensin-aldosterone and sympathetic activity. It is cleared by cell uptake, breakdown by neutral endopeptidase and the kidneys.

Binds natriuretic peptide receptor A
Receptor activation raises cGMP
Veins and arteries dilate; filling pressure falls
Some natriuresis; RAAS and sympathetic tone fall

Indications

Acutely decompensated heart failure with breathlessness at rest or minimal activity Heart failure →

Adverse effects

Common

Hypotension (the most common, dose-related)
Headache
Nausea
Rise in blood urea in people with poor kidney function

Contraindications

Cardiogenic shock (as primary therapy)
Low systolic blood pressure
Hypersensitivity to any component

Key interactions

Oral ACE inhibitors: More hypotension.
Heparin, insulin, furosemide, hydralazine (same line): Physically incompatible: not infused through the same catheter.

What is monitored

Blood pressure closely during the infusion
Urine output, creatinine and urea
Symptoms of congestion and breathlessness

Administration and safety

Intravenous infusion in hospital with blood-pressure monitoring.
Infused through its own line: incompatible with heparin, insulin, furosemide and hydralazine in the same catheter.
If hypotension occurs, the infusion is stopped and restarted only when pressure recovers.

Pregnancy and breastfeeding

Experience in pregnancy is minimal; it is used only if clearly needed.

Nursing care

Before: measure blood pressure and check kidney function.
During: check blood pressure frequently; lay the patient flat if hypotensive and inform the team.
Record urine output and daily weight.
Watch for breathlessness, headache and arrhythmias.

Pharmacokinetics

Absorption: Intravenous only.
Elimination: Taken up and broken down by cells, cleaved by neutral endopeptidase, and filtered by the kidneys.
Half-life: Short (about 18 minutes in its terminal phase); the effect on pressure lasts longer.

Test yourself

Think of the answer, then tap the question to see it.

Which natural hormone is nesiritide a copy of?

B-type natriuretic peptide (BNP).

Which second messenger rises when its receptor is activated?

cGMP.

What is the main dose-limiting adverse effect of nesiritide?

Hypotension.

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Connections

← Back to the class: Direct vasodilators

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Nesiritide — A New Agent For Acute Decompensated Heart Failure (Medical Journal Armed Forces India, via PubMed Central, 2005); Atrial Natriuretic Peptide Receptor complexed with deletion mutant of human Atrial Natriuretic Peptide[5-27] (RCSB Protein Data Bank, 2021); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.