Science or fiction: use of nesiritide as a first-line agent?
Nesiritide is an effective agent for the treatment of decompensated CHF. However, the VMAC trial shows that the agent's efficacy and safety are actually more similar than dissimilar to those of nitroglycerin. Indeed, objective reviews have placed nesiritide as a second-line agent behind current standard drug therapy. Finally, nesiritide is approximately 40 times the purchase price of standard agents such as nitroglycerin. For these reasons, we feel that nesiritide should not be considered as first-line therapy. Reflecting this notion, one institution has implemented a protocol that recommends administration of nitroglycerin and intravenous diuretics (using > or = 2 times the usual daily diuretic dose) before using nesiritide. In light of the existing data, we feel that this approach appears to be an appropriate and prudent one for nesiritide's place in therapy.
Noviasky
John A
JA
Department of Pharmacy, St. Elizabeth Medical Center, Utica, New York 13502, USA. NoviaskyJ@yahoo.com
Kelberman
Michael
M
Whalen
Karen M
KM
Guharoy
Roy
R
Darko
William
W
D000208:Acute Disease; D017048:Health Care Costs; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005996:Nitroglycerin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome
D020097:Natriuretic Peptide, Brain; D005996:Nitroglycerin