Nesiritide (Natrecor)_Dosage, benefits & legal status
Also known as Natrecor, nesiritide citrate, BNP-32, recombinant human BNP, rhBNP, recombinant human B-type natriuretic peptide, brain natriuretic peptide 32, nesiritide recombinant
Recombinant human B-type natriuretic peptide, a 32-residue hormone that relaxes blood vessels. It lowered heart pressures within hours but did not reduce deaths or readmissions in the 7,141-patient ASCEND-HF trial.
Common vial size is what vendors typically sell, not a recommendation. Enter your own vial in the calculator.
What is Nesiritide (Natrecor)?
Plain language first. The technical label stays, but it never stands alone.Overview
When heart failure suddenly worsens, fluid backs up into the lungs and breathing becomes hard, and doctors need fast ways to lower the pressure inside the heart. Given as a drip, nesiritide lowered that pressure by 5.8 mm Hg at 3 hours in the VMAC trial, against 3.8 with nitroglycerin and 2.0 with placebo. In the 7,141-patient ASCEND-HF trial it did not reduce deaths or readmissions (9.4% against 10.1% by day 30), its effect on breathlessness was small and short of the trial's significance thresholds, and low blood pressure was more common. The US product stopped being sold in 2020.
Nesiritide is recombinant human B-type natriuretic peptide (BNP-32), made in E. coli with the same 32-residue sequence as the hormone the heart's ventricles release, closed into a 17-residue ring by a Cys10 to Cys26 disulfide (C143H244N50O42S4, 3464 g/mol), and supplied as the citrate salt. It binds the particulate guanylate cyclase receptor (natriuretic peptide receptor A) on vascular smooth muscle and endothelial cells, raising cGMP and relaxing veins and arteries to lower filling pressure in the heart. Scios developed it, and the FDA approved it as Natrecor on August 10, 2001 for acutely decompensated heart failure with breathlessness at rest or on minimal activity.
What it's used for
A hospital drip for adults with suddenly worsening heart failure who are breathless at rest or on minimal activity. No longer sold in the US.
How does Nesiritide (Natrecor) work?
What it does in the body, and where.Nesiritide is the heart's own pressure-relief hormone, made in bacteria and given by drip.
- 01The natural signalWhen the heart's ventricles are stretched by fluid overload, they release B-type natriuretic peptide. Nesiritide has exactly the same 32 residues, made in E. coli.
- 02Relaxing the vesselsIt binds natriuretic peptide receptor A, a guanylate cyclase on blood-vessel muscle and lining cells, and raises cGMP inside them. Veins and arteries relax, the filling pressure in the heart falls (by 5.8 mm Hg at 3 hours in VMAC) and breathing can ease.
- 03Gone in minutesIt is cleared within minutes, with a terminal half-life of about 18 minutes; the 2001 label named clearance receptors, enzymes such as neutral endopeptidase and the kidneys. That is why it has to run as a continuous drip.
A schematic of the compound's mechanism, not a diagnostic image.
What else is it used for?
Each group carries its own evidence level.Approved means regulators have cleared it for that purpose. Investigational means it is in trials. Early research means it is being studied and is not established.
Heart pressures and breathlessness (VMAC)
FDA-approved- Human trial489 inpatients breathless at rest: wedge pressure fell 5.8 mm Hg at 3 hours against 3.8 with nitroglycerin and 2.0 with placebo.
- Human trialBreathlessness improved more than on placebo, but global clinical status did not differ from nitroglycerin.
Outcomes (ASCEND-HF)
tested-and-failed- Human trial7,141 patients: death or heart failure readmission by day 30, 9.4% against 10.1% (P=0.31); deaths 3.6% against 4.0% at 30 days and 12.3% against 12.7% at 180 days.
- Human trialBreathlessness better in 44.5% against 42.1% at 6 hours and 68.2% against 66.1% at 24 hours, short of the prespecified thresholds.
- No dataSymptomatic low blood pressure 7.1% against 4.0%; worsening kidney function 31.4% against 29.5% (P=0.11).
The 2005 safety signal
peer-reviewed-human- ReviewMeta-analysis of 3 trials: 30-day deaths 7.2% against 4.0% (risk ratio 1.74, 95% CI 0.97 to 3.12, P=.059), not statistically significant.
- ReviewA second meta-analysis of 5 trials and 1,269 patients found more worsening kidney function (risk ratio 1.54) but no difference in dialysis.
- No dataASCEND-HF later found no excess deaths, and the label's pooled analysis gives a 30-day HR of 0.99 across seven studies.
Outpatient infusions (FUSION II)
tested-and-failed- Human trial911 patients with advanced chronic heart failure given infusions once or twice a week for 12 weeks: death or heart or kidney hospitalization 36.7% against 36.8% (HR 1.03); deaths 9.5% against 9.6%.
Low dose for the kidneys (ROSE-AHF)
tested-and-failed- Human trial360 patients with acute heart failure and reduced kidney function: 0.005 mcg/kg/min without a bolus gave 72-hour urine output of 8.6 against 8.3 L (P=0.49) and no change in cystatin C.
Nesiritide is often said to increase deaths. The 2005 signal (7.2% against 4.0% at 30 days, risk ratio 1.74, P=.059) was not statistically significant, and ASCEND-HF later found 3.6% against 4.0% at 30 days and 12.3% against 12.7% at 180 days. ASCEND-HF is also reported as showing no effect on breathlessness: the nominal P values were 0.03 and 0.007, but both missed the prespecified thresholds, and the authors called the effect small and nonsignificant. It was not withdrawn by the FDA; the firm discontinued it, and the FDA has determined it was not withdrawn for safety or effectiveness reasons. FDA NDC data give June 15, 2020 as the end of US marketing, though one secondary source dates the end of US production to 2018. Low blood pressure figures depend on the comparison: 12% against 4% on placebo in the first 24 hours of pooled trials, 7.1% against 4.0% symptomatic in ASCEND-HF, and 4% against 5% with nitroglycerin in VMAC, where it lasted longer. Approval rested on 10 trials with 941 heart failure patients per the 2001 label, also quoted as 10 trials with 1,456. FUSION II enrolled 920 and randomized 911, and Scios called it phase 2. The label's stated experience moved from 48 hours (2001) to 96 hours (2019). The BNP and NT-proBNP blood tests measure the body's own hormone; they are not this drug. China's recombinant BNP product is often called nesiritide; one drug database calls it a biosimilar, while its maker calls it its own Class 1 new biologic.
The published record
Papers and trials about Nesiritide (Natrecor)
471 papers tagged human · 240 not reviews or lab · 90 clinical trial publications
288 registered trials · 14 with posted results
Furthest stage reached: Approved in the US, no longer sold
Counted from Europe PMC indexing, not read by a person; a human tag can land on reviews, commentary or lab papers; clinical trial publications is the narrower count. 433 papers and 100 trials indexed in detail.
At a glance
Four things to know about Nesiritide (Natrecor)
Evidence
FDA-approved
Category
Sexual and hormonal
Common vial
Varies
Half-life
About 18 minutes (a first phase of about 2 minutes)
How much, and do you cycle it?
The range, and whether you take breaks.2 mcg/kg bolus, then 0.01 mcg/kg/min infusion (label), one continuous infusion during a hospital stay. One infusion during a hospital admission Discontinued
Run continuously while the patient is in the hospital, with limited experience beyond 96 hours. Scheduled repeat infusions were tested in FUSION II and gave no benefit.
How long does it stay in the body?
The half-life, and where the figure comes from.About 18 minutes (a first phase of about 2 minutes)Discontinued label
Mean terminal half-life about 18 minutes, covering about two-thirds of exposure. Clearance about 9.2 mL/min/kg, proportional to body weight and unaffected by age, sex, race or heart failure severity; volume of distribution 0.19 L/kg at steady state. The 2001 label described three clearance routes: clearance receptors, neutral endopeptidase-type enzymes and the kidneys.
Source: Natrecor US prescribing information (2019), section 12.3
You can compare this against the whole library to see where it sits.
How is it given?
Dosing context and source notes.Given in hospital from a prepared product, so there is nothing to mix.
Label dose: 2 mcg/kg per dose. Natrecor US prescribing information (January 2019), section 2
The label regimen was a 2 mcg/kg intravenous bolus over about 60 seconds, then a continuous infusion of 0.01 mcg/kg/min from a 6 mcg/mL bag (bolus volume in mL equal to weight in kg divided by 3; infusion rate in mL/hr equal to weight in kg times 0.1). The bolus may not suit patients with systolic pressure below 110 mm Hg or recent use of afterload-reducing drugs. If blood pressure falls, the infusion is reduced or stopped, then restarted 30% lower with no bolus once stable. Increases were allowed no more often than every 3 hours with central pressure monitoring, up to 0.03 mcg/kg/min, and experience beyond 96 hours is limited. No kidney adjustment was needed. It came as a 1.5 mg freeze-dried powder vial for hospital use. The US product is no longer sold, and it was dosed by weight as a drip, so the calculator cannot produce a draw.
How do you store it?
Before mixing, and after.Given in a hospital or trial clinic, so the pharmacy stores it.
Nesiritide (Natrecor) goes into a vein and is prepared by hospital, clinic or trial pharmacy staff, following the product label or the trial protocol. Some products like this are ready-made solutions and others are powders mixed just before use, often with hours rather than weeks of shelf life once prepared. It is not a medicine people store at home.
What are the side effects and cautions?
Known cautions and warnings for this compound.Solubility, computed: 31% charged residues, 34% hydrophobic. Water usually sufficient.
A first-pass rule from peptide manufacturers' guidance. It does not account for disulfide bridges, salt form or how the powder was dried, and it predicts what should be easy rather than what will happen in your vial.
Who should avoid it
- Systolic blood pressure persistently below 100 mm Hg before treatment
- Cardiogenic shock
- Allergy to nesiritide or its ingredients
- Low cardiac filling pressures, narrowed heart valves, restrictive or obstructive cardiomyopathy, constrictive pericarditis or cardiac tamponade: the label advises against use
Stop and get help
- Falling blood pressure, dizziness or fainting: the infusion is reduced or stopped and blood pressure supported
- Signs of a serious allergic reaction, such as swelling of the face or throat or trouble breathing
Common effects
- Low blood pressure in 12% against 4% on placebo in the first 24 hours of pooled trials; symptomatic in 7.1% against 4.0% in ASCEND-HF
- Headache 7% against 6%, nausea 3% against 1%, back pain 3% against 1% and dizziness 2% against 2%
- Against nitroglycerin in VMAC, low blood pressure was about as frequent (4% against 5%) but lasted longer (a mean of 2.2 against 0.7 hours)
- Kidney function: a fall in GFR of more than 25% in 31.4% against 29.5% in ASCEND-HF; creatinine up more than 0.5 mg/dL in 28% against 21% with nitroglycerin in VMAC
Where this page says nothing is established, that means nobody has studied it, not that a compound is safe.
Is Nesiritide (Natrecor) approved?
And where the numbers on this page come from.Approved, but no longer sold in the United States. Nesiritide (Natrecor) was approved by the FDA, and the US product has since been discontinued.
- Approval statusFDA-approved
- RouteInto a vein (bolus, then infusion)
- Checked17 October 2026
- DoseFrom a discontinued product or program. No current label supports this dose.
- Vial sizeFrom what vendors typically list; not a recommendation.
- SourcesDrugs@FDA, NDA 020920 (Natrecor)Natrecor US prescribing information (January 2019)Natrecor original US label (2001)FDA GSRS substance record, nesiritide (UNII P7WI8UL647)O'Connor CM et al., New England Journal of Medicine 2011;365:32-43 (ASCEND-HF)Publication Committee for the VMAC Investigators, JAMA 2002;287:1531-1540Sackner-Bernstein J et al., JAMA 2005;293:1900-1905Sackner-Bernstein JD et al., Circulation 2005;111:1487-1491MDedge, expert panel calls for limiting nesiritide use (2005)US Department of Justice, Scios pleads guilty (October 5, 2011)ACC summary, FUSION II (Yancy CW et al., Circulation: Heart Failure 2008;1:9-16)ACC summary, ROSE-AHF (Chen HH et al., JAMA 2013;310:2533-2543)FDA NDC data for 65847-205, via NDC ListPatsnap Synapse, recombinant human BNP (China)Health Canada, Summary Basis of Decision for Natrecor
What has happened recently
The FDA approved Natrecor (Scios, NDA 020920) on August 10, 2001, as a new molecular entity for intravenous treatment of acutely decompensated heart failure with breathlessness at rest or on minimal activity. Johnson & Johnson agreed to buy Scios on February 10, 2003, for about $2.4 billion. After 2005 meta-analyses raised concerns about deaths and kidney function, an expert panel of 10 cardiologists convened by Scios and chaired by Eugene Braunwald recommended on June 8, 2005 that use be limited to hospitalized patients with acute heart failure and breathlessness, with no scheduled or outpatient infusions and no use to improve kidney function or replace diuretics, and endorsed Scios's plan for a large outcomes trial; Scios accepted every recommendation, and the trial became ASCEND-HF. On October 5, 2011, Scios pleaded guilty to a misdemeanor misbranding charge for promoting serial infusions in chronic heart failure and paid an $85 million criminal fine. The last label update was January 9, 2019. FDA NDC directory data give June 15, 2020 as the end of US marketing, and Drugs@FDA lists Natrecor as discontinued; no company announcement was found, and Drugs@FDA notes a Federal Register determination that it was not discontinued or withdrawn for safety or effectiveness reasons. No generic was approved. In China, a recombinant human brain natriuretic peptide for injection sold as Xinhuosu (Tibet Rhodiola Pharmaceutical) was approved on April 11, 2005, according to a drug database, for acutely decompensated heart failure and remains on the national reimbursement list; whether its sequence is identical to nesiritide has not been confirmed from a primary source. Health Canada authorized Natrecor with conditions on November 8, 2007, pending confirmation of benefit in ASCEND-HF; its Canadian listing (DIN 02301393) now shows as canceled after marketing. No EU or Japanese approval of nesiritide was found.
You can compare this against the whole library, or read how to check a seller.
What else is like Nesiritide (Natrecor)?
Others in Sexual and hormonal, side by side.If you're weighing Nesiritide (Natrecor), it's worth reading PT-141 (Bremelanotide), Kisspeptin, and Gonadorelin (GnRH) in the same class.
Recombinant human B-type natriuretic peptide, a 32-residue hormone that relaxes blood vessels. It lowered heart pressures within hours but did not reduce deaths or readmissions in the 7,141-patient ASCEND-HF trial.
- Dose
- 2 mcg/kg bolus, then 0.01 mcg/kg/min infusion (label)
- How often
- One continuous infusion during a hospital stay
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- Dose
- 0.1 up to 0.2 mg per dose
- How often
- Daily in vendor protocols
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- Dose
- 0.1 up to 0.2 mg per dose (start low, increase slowly)
- How often
- 2-3x per week or more
Guides for this compound
- How to Reconstitute a Peptide
Mix peptide powder with bacteriostatic water, step by step.
- How to Read an Insulin Syringe
Read the units, convert to millilitres, and draw the exact dose.
- mcg vs mg: The Peptide Dosing Mistake to Avoid
Your vial says mg and your protocol says mcg. Here is the conversion and how to check it.
Sources
- Drugs@FDA, NDA 020920 (Natrecor)(2026)Approved August 10, 2001 as a new molecular entity; Scios LLC; listed as discontinued, with a Federal Register determination that it was not withdrawn for safety or effectiveness reasons.
- Natrecor US prescribing information (January 2019)(2019)2 mcg/kg bolus then 0.01 mcg/kg/min; terminal half-life about 18 minutes; hypotension 12% against 4%; pooled 30-day mortality HR 0.99 and 180-day HR 0.98.
- Natrecor original US label (2001)(2001)Original indication; 10 trials with 941 heart failure patients; three clearance routes for human BNP.
- FDA GSRS substance record, nesiritide (UNII P7WI8UL647)(2026)32-residue human sequence with a Cys10 to Cys26 disulfide; CAS 124584-08-3; no modifications.
- O'Connor CM et al., New England Journal of Medicine 2011;365:32-43 (ASCEND-HF)(2011)7,141 patients: death or heart failure readmission by day 30, 9.4% against 10.1% (P=0.31); dyspnea gains missed the prespecified thresholds.
- Publication Committee for the VMAC Investigators, JAMA 2002;287:1531-1540(2002)489 patients: wedge pressure fell 5.8 mm Hg at 3 hours against 3.8 with nitroglycerin and 2.0 with placebo.
- Sackner-Bernstein J et al., JAMA 2005;293:1900-1905(2005)Three trials: 30-day deaths 7.2% against 4.0% (risk ratio 1.74, 95% CI 0.97 to 3.12, P=.059).
- Sackner-Bernstein JD et al., Circulation 2005;111:1487-1491(2005)Five trials, 1,269 patients: worsening kidney function risk ratio 1.54 (95% CI 1.19 to 1.98); no difference in dialysis.
- MDedge, expert panel calls for limiting nesiritide use (2005)(2005)June 8, 2005 Braunwald panel recommendations, all accepted by Scios.
- US Department of Justice, Scios pleads guilty (October 5, 2011)(2011)Misdemeanor misbranding plea and $85 million fine for promoting serial infusions in chronic heart failure.
- ACC summary, FUSION II (Yancy CW et al., Circulation: Heart Failure 2008;1:9-16)(2007)911 patients with advanced chronic heart failure: death or hospitalization 36.7% against 36.8% at 12 weeks (HR 1.03).
- ACC summary, ROSE-AHF (Chen HH et al., JAMA 2013;310:2533-2543)(2013)360 patients with kidney impairment: low-dose nesiritide did not raise 72-hour urine output (8.6 against 8.3 L) or improve cystatin C.
- FDA NDC data for 65847-205, via NDC List(2026)Marketing started August 1, 2001 and ended June 15, 2020; listing discontinued by the firm.
- Patsnap Synapse, recombinant human BNP (China)(2025)Tibet Rhodiola's recombinant human BNP approved in China on April 11, 2005 for heart failure.
- Health Canada, Summary Basis of Decision for Natrecor(2007)Authorization with conditions on November 8, 2007, for hospitalized adults with acutely decompensated heart failure, pending confirmation of benefit.
Beyond these, 533 records are indexed. Browse the records