Cardiovascular & General; Hormonal & Sexual Health / Cardiovascular

Nesiritide

Nesiritide is a manufactured copy of the hormone the heart releases when it is overloaded — the idea being to give a failing heart more of its own distress signal, which relaxes blood vessels and lowers the pressure it has to pump against. It does exactly that, and the US Food and Drug Administration approved it in 2001 for patients admitted with acute heart failure. A decade later the definitive trial arrived: ASCEND-HF randomised 7,141 patients and found breathlessness barely shifted, with death or readmission within 30 days at 9.4% on nesiritide against 10.1% on placebo. The product is now listed as discontinued and carries no current label.

Last updated 12 August 2026

Studied forVasodilation in heart failure · Filling pressure reduction · Dyspnoea outcome data

Evidence on fileFDA-approved · 1 randomised human trial · 1 human observational study

Strongest sourceIntravenous Nesiritide, a Natriuretic Peptide, in the Treatment of Decompensated Congestive Heart Failure (Ne… (randomised human trial)

Mechanism

Binds natriuretic peptide receptor-A, raising cyclic GMP to relax vascular smooth muscle and lower cardiac filling pressures.

Regulatory status

Approved by the FDA. Marketed as NATRECOR. Earliest approval 2001-08-10. Application NDA020920.

An approval grades as rung 1 on this site, because 21 CFR 314.126 requires adequate and well-controlled human investigations and one cannot be granted without them. It covers specific indications and doses, though, and does not transfer to other uses of the same molecule.

Reported effects

What sources associate with this compound. Reported categories, not outcomes we have graded — each would need its own citation and rung.

Vasodilation in heart failure
Filling pressure reduction
Dyspnoea outcome data

Dosing on file unverified

IV bolus: 2 mcg/kg; then continuous: 0.01 mcg/kg/min (max 48h); IV bolus: 2 mcg/kg over ~60 sec; then continuous infusion: 0.01 mcg/kg/min (max 48h)

Carried from a source that labels it unverified, and reproduced with that label attached. A record of what is reported, not a recommendation. No citation on this page establishes it.

Half-life, storage & sport

Elimination half-life: 20 min (human, IV) — study. Pharmaceutical research 2025; clinical use in acute decompensated heart failure.

The half-life on file is 20 min, measured intravenously. No dosing schedule could be read from this record, so the curve below is one dose drawn from the moment it is given. Nothing here says how often it is repeated.

One dose. 1.7 h of decay, normalised to its own peak.

The rise is not modelled and the axis is not a blood level. No absorption rate constant and no volume of distribution are on file, so each dose appears at full height the instant it is given, and the axis is percent of this compound's own peak.

Literature on file 3

human observational
Effect of Nesiritide in Patients with Acute Decompensated Heart Failure (New England Journal of Medicine 2011, cited 1102x) graded on: a synthesis of human studies — read from the indexed abstract — “meta-analyses”
human RCT
Intravenous Nesiritide, a Natriuretic Peptide, in the Treatment of Decompensated Congestive Heart Failure (New England Journal of Medicine 2000, cited 770x) graded on: names a randomised controlled trial — the indexed publication type — “Randomized Controlled”
human RCT
FDA approval NDA020920 graded on: an FDA approval (NDA020920), which requires adequate and well-controlled human investigations — “NDA020920”

Identity

Space-filling 3D model of Nesiritide, carbon grey, nitrogen blue, oxygen red — Built from the SMILES on this record — the atoms and bonds are exact. The shape is **one computed low-energy pose**, not a measured structure: a flexible peptide in solution has no single conformation, and where the SMILES leaves a stereocentre undefined the pose commits to one arbitrarily. The skeletal formula below claims connectivity and nothing more, which is what we actually know.

2D chemical structure of Nesiritide — Built from the SMILES on this record — the atoms and bonds are exact. The shape is **one computed low-energy pose**, not a measured structure: a flexible peptide in solution has no single conformation, and where the SMILES leaves a stereocentre undefined the pose commits to one arbitrarily. The skeletal formula below claims connectivity and nothing more, which is what we actually know.

Molecular weight: 3464.0
Molecular formula: C143H244N50O42S4
CAS number: 124584-08-3
PubChem CID: 71308561
UniProt: P16860
InChI key: HPNRHPKXQZSDFX-OAQDCNSJSA-N
SMILES: CC[C@H](C)[C@H]1C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)NCC(=O)N[C@H](C(=O)NCC(=O)N[C@@H](CSSC[C@@H](C(=O)N[C@H](C(=O)NCC(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@H](C(=O)N1)CCCNC(=N)N)CC(=O)O)CCSC)CCCCN)CCCNC(=N)N)CC2=CC=CC=C2)NC(=O)CNC(=O)[C@H](CO)NC(=O)CNC(=O)[C@H](CCC(=O)N)NC(=O)[C@H](C(C)C)NC(=O)[C@H](CCSC)NC(=O)[C@H](CCCCN)NC(=O)[C@@H]3CCCN3C(=O)[C@H](CO)N)C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C(C)C)C(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CCCNC(=N)N)C(=O)N[C@@H](CCCNC(=N)N)C(=O)N[C@@H](CC4=CNC=N4)C(=O)O)CC(C)C)CO)CO)CO)CO
InChI: InChI=1S/C143H244N50O42S4/c1-13-76(10)112-137(232)189-99(68-199)131(226)188-98(67-198)130(225)187-97(66-197)129(224)186-96(65-196)117(212)166-59-105(202)169-90(52-72(2)3)114(209)163-61-107(204)171-100(132(227)177-83(32-19-22-44-146)124(219)190-111(75(8)9)136(231)184-91(53-73(4)5)127(222)175-84(34-24-46-159-141(151)152)121(216)174-85(35-25-47-160-142(153)154)122(217)185-94(139(234)235)55-78-57-157-71-167-78)69-238-239-70-101(172-108(205)62-165-116(211)95(64-195)170-106(203)60-162-113(208)87(38-39-103(148)200)181-135(230)110(74(6)7)191-126(221)89(41-51-237-12)179-120(215)82(31-18-21-43-145)180-134(229)102-37-27-49-193(102)138(233)79(147)63-194)133(228)182-92(54-77-28-15-14-16-29-77)115(210)164-58-104(201)168-80(33-23-45-158-140(149)150)118(213)173-81(30-17-20-42-144)119(214)178-88(40-50-236-11)123(218)183-93(56-109(206)207)128(223)176-86(125(220)192-112)36-26-48-161-143(155)156/h14-16,28-29,57,71-76,79-102,110-112,194-199H,13,17-27,30-56,58-70,144-147H2,1-12H3,(H2,148,200)(H,157,167)(H,162,208)(H,163,209)(H,164,210)(H,165,211)(H,166,212)(H,168,201)(H,169,202)(H,170,203)(H,171,204)(H,172,205)(H,173,213)(H,174,216)(H,175,222)(H,176,223)(H,177,227)(H,178,214)(H,179,215)(H,180,229)(H,181,230)(H,182,228)(H,183,218)(H,184,231)(H,185,217)(H,186,224)(H,187,225)(H,188,226)(H,189,232)(H,190,219)(H,191,221)(H,192,220)(H,206,207)(H,234,235)(H4,149,150,158)(H4,151,152,159)(H4,153,154,160)(H4,155,156,161)/t76-,79-,80-,81-,82-,83-,84-,85-,86-,87-,88-,89-,90-,91-,92-,93-,94-,95-,96-,97-,98-,99-,100-,101-,102-,110-,111-,112-/m0/s1

Notes unverified prose

FDA-approved (Natrecor); Drugs.com; See Hormonal & Sexual Health

Not on file 1

1 of the 8 fields we track hold nothing on this record, and each says why. A blank field is a bug; a named absence is a finding.

amino-acid sequencenothing we hold supplies it

Each field links to every other record missing the same thing. The full ledger holds 765 gaps across 163 records.