Nesiritide is a recombinant form of human B-type natriuretic peptide (BNP), a 32-amino-acid peptide (MW ~3464 g/mol) with a 17-residue disulfide ring structure. It was FDA-approved in August 2001 for acute decompensated heart failure (ADHF) under the brand name Natrecor. Clinical use declined substantially after the ASCEND-HF trial (2011) demonstrated no mortality benefit and no reduction in heart failure rehospitalization compared to placebo.
Category: Cardiovascular / Natriuretic. Evidence rating: A (strong human clinical data).
Clinical status: FDA-approved (Natrecor, August 2001) for acute decompensated heart failure. Use declined significantly after ASCEND-HF trial (2011) showed no mortality benefit.
Nesiritide binds to natriuretic peptide receptor A (NPR-A), a particulate guanylyl cyclase receptor, stimulating intracellular cGMP production. Elevated cGMP activates protein kinase G (PKG), which reduces intracellular calcium in vascular smooth muscle, producing venous and arterial vasodilation.…
Safety considerations: Hypotension is the most common adverse effect (dose-dependent); occurred in 11% vs 4% with nitroglycerin in VMAC; ASCEND-HF showed significantly more symptomatic hypotension with nesiritide vs placebo (26.6% vs 15.3%, p<0.001); Earlier meta-analyses raised concerns about worsening renal function, though ASCEND-HF did not confirm this.
Reviewed by the PeptideAtlas Editorial Team.
| Molecular weight | ~3464 g/mol |
|---|---|
| CAS number | 114471-18-0 |
| Half-life | ~18 minutes |
| Production method | recombinant |
| Anti-doping status | not-listed |
| US regulatory status | FDA-approved (Natrecor, August 2001) for IV treatment of acute decompensated heart failure with dyspnea at rest. Use has declined substantially after ASCEND-HF trial results. |
Related peptides: Atrial Natriuretic Peptide, B-type Natriuretic Peptide.
The ASCEND-HF trial (2011, n=7,141) definitively showed that nesiritide did not reduce 30-day mortality or heart failure rehospitalization despite improving dyspnea symptoms. Combined with significant hypotension risk and the availability of effective diuretic therapy, most clinicians have moved away from routine nesiritide use.
Nesiritide (Natrecor) remains FDA-approved but is rarely used in current clinical practice. It is still mentioned in heart failure guidelines as a potential adjunct for hemodynamic support in acute decompensated heart failure refractory to standard therapy.
Nesiritide is exogenous recombinant BNP given IV for acute heart failure. Sacubitril (part of Entresto/sacubitril-valsartan) is a neprilysin inhibitor that prevents breakdown of endogenous natriuretic peptides, given orally for chronic heart failure with reduced ejection fraction. They both work through the natriuretic peptide pathway but with different approaches and clinical settings.