FDA-approved
Heart & blood
Nesiritide
Also called hBNP
Nesiritide is a lab-made copy of the heart hormone BNP, approved for acute heart failure. See how it works, what trials found, and its side effects.
- Reviewed by
- William Maish, MD MBA MPH, Clinical Product Lead
- Published
- October 5, 2026
- Last updated
- October 5, 2026
Key takeaway
Nesiritide (sold as Natrecor) is a laboratory-made copy of B-type natriuretic peptide, a hormone the heart releases when it is under strain, developed as an intravenous treatment for acute heart failure. It relaxes blood vessels and lowers heart-filling pressures, but a large trial later found it did not reduce death or rehospitalization. As of 2026 it has been FDA-approved in the U.S. since 2001, though it has largely been withdrawn from the market.
At a glance
| What it is | Recombinant human B-type natriuretic peptide (BNP), a vasodilator |
| Approved for | Acute decompensated heart failure with shortness of breath at rest or minimal activity |
| Key fact | In the large ASCEND-HF trial it did not improve survival or rehospitalization and had only a small effect on symptoms |
| Route | Intravenous |
| Evidence strength | FDA-approved (discontinued) |
What is nesiritide?
Nesiritide, sold under the brand Natrecor, is a recombinant form of human B-type natriuretic peptide (BNP), a hormone normally released by the heart's ventricles when they are stretched by excess pressure or volume. The drug was designed to amplify that natural signal in acute heart failure, promoting vessel relaxation and fluid removal. It was approved in the United States in 2001 and has since been largely withdrawn from the market for commercial reasons.
How does nesiritide work?
Nesiritide reproduces the 32-amino-acid sequence of human BNP and binds the natriuretic peptide receptor-A, raising the second messenger cyclic GMP in blood-vessel walls. This relaxes both arteries and veins, lowering the pressure the heart has to pump against and the pressure filling it (reflected as a lower pulmonary capillary wedge pressure). It also promotes sodium and water excretion by the kidney and dampens the renin-angiotensin-aldosterone system.
Those effects improve the hemodynamics of acute heart failure, but the two key trials reached different results:
| Trial | Findings |
| VMAC, the earlier trial | Nesiritide lowered filling pressure more than nitroglycerin or placebo and improved breathing at 3 hours |
| ASCEND-HF, the larger later trial | Only a small, non-significant effect on dyspnea and no benefit1 on 30-day death or rehospitalization, while increasing episodes of low blood pressure |
That gap between short-term hemodynamics and hard outcomes is the central story of the drug.
Is it FDA-approved?
Yes. Nesiritide was approved by the FDA in 2001 for acute decompensated heart failure in patients with shortness of breath at rest or with minimal activity. After the neutral ASCEND-HF results and shifting practice, the product was largely withdrawn from the U.S. market, so its approval is now mainly of historical interest.
What is nesiritide prescribed for?
Nesiritide was prescribed for intravenous treatment of acute decompensated heart failure to relieve shortness of breath, given in a monitored hospital setting. In current practice it is rarely used, both because of the ASCEND-HF findings and because the product has been largely withdrawn.
What are the side effects?
Common side effects include:
- Low blood pressure, which can be symptomatic or prolonged
- Headache
- Nausea
More serious considerations include:
- Significant hypotension, the main safety concern
- Slowed heart rate
- Earlier concerns about worsening kidney function, which were not confirmed in ASCEND-HF
More for heart & blood
Sources: FDA prescribing information for Natrecor; the VMAC trial (2002) and O'Connor et al. (2011), the ASCEND-HF trial. PubMed-indexed studies are cited by DOI where used. This article is for educational purposes only and is not medical advice.