title: Science or fiction: use of nesiritide as a first-line agent?
abstract: 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.
authors.affiliation: Department of Pharmacy, St. Elizabeth Medical Center, Utica, New York 13502, USA. NoviaskyJ@yahoo.com
authors.forename: John A
authors.initials: JA
authors.lastname: Noviasky
authors.forename: Michael
authors.initials: M
authors.lastname: Kelberman
authors.forename: Karen M
authors.initials: KM
authors.lastname: Whalen
authors.forename: Roy
authors.initials: R
authors.lastname: Guharoy
authors.forename: William
authors.initials: W
authors.lastname: Darko
mesh_terms: 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
chemical_list: D020097:Natriuretic Peptide, Brain; D005996:Nitroglycerin