Recombinant version of BNP, a hormone made by the heart. It was approved for acute decompensated heart failure, but a large trial showed little benefit and it is now discontinued in the US.
Regulatory status
Approved (FDA / EMA)
Family
Recombinant B-type natriuretic peptide
Scientific evidence
High
Number of findings
1
Where it acts
Heart and blood
Also known as
nesiritide, Natrecor, recombinant BNP
Regulatory status
FDA (US): Approved (2001, Natrecor) for acutely decompensated heart failure with dyspnea; now discontinued in the US
EMA (EU): Not approved
Dose
IV bolus of 2 µg/kg followed by an infusion of 0.01 µg/kg/min (FDA label, Natrecor).
Safety
Frequent hypotension (may be symptomatic); possible worsening of kidney function. Does not improve survival or readmissions. Hospital use only and under medical supervision.
Interactions
Higher risk of hypotension with ACE inhibitors, nitrates, and other vasodilators.
Effect by goal · level of evidence
Acute heart failure: no benefit on mortality or readmissions
no clear effectHighRCT (AA)in people
No change in death
In ASCEND-HF (7,141 patients), the improvement in breathlessness was minimal and did not reach the prespecified significance. Death or readmission at 30 days did not change (9.4% vs 10.1%) and there was more hypotension.
It mimics natural BNP: it dilates veins and arteries, helps eliminate sodium and water in the urine, and reduces the filling pressure of the heart. The aim is to relieve the feeling of breathlessness.
What the evidence says
In people
Acute heart failure: no benefit on mortality or readmissions. In ASCEND-HF (7,141 patients), the improvement in breathlessness was minimal and did not reach the expected significance. Death or rehospitalization at 30 days did not change (9.4% vs 10.1%) and there was more hypotension. PubMed 21732835