Evidence review: Open Peptide Project (verified against primary PubMed, ClinicalTrials.gov & FDA records) · Last checked 2026-10-27. ← Back to Evidence Library
Nesiritide (Natrecor): what the evidence says
At a glance
What it is: recombinant human B-type natriuretic peptide, approved as Natrecor for acutely decompensated heart failure; Drugs@FDA now lists it as discontinued. R1
What the evidence says: VMAC (489 patients) found it lowered heart filling pressure and eased breathlessness at 3 hours vs placebo. R2 ASCEND-HF (7,141 patients) found no change in 30-day death or rehospitalization (9.4% vs 10.1%) and only a small, non-significant effect on breathlessness. R3, R4
Biggest risks: more low blood pressure; no worsening of kidney function in ASCEND-HF. R3
Rating
| Human Human evidence | Strong negative outcome data (n = 7,141) R3; short-term hemodynamic benefit (n = 489) R2 |
| Animal Animal / lab evidence | Not reviewed |
| Regulatory | FDA-approved, discontinued R1 · not on FDA's 503A or 503B bulk-substance category lists and not on FDA's compounding safety-risk page R5, R6, R7 · not named by WADA R8 |
| Established human dose | Label dose existed (see Study details) |
Evidence verdict: Acute heart failure breathlessness: Weak (tiny, non-significant benefit in 7,141-patient RCT) · Death or rehospitalization: no effect · Hypotension: increased
This page reports what studies used. It is not dosing advice.
Legend: HUMAN data · ANIMAL / LAB data · UNKNOWN · UNVERIFIED: not yet confirmed against a primary source
About the evidence: ASCEND-HF concluded it cannot be recommended for routine use in acute heart failure. R3
What is it?
Related pages: Vosoritide, B7-33, VIP.
Does it work?
- Human VMAC: faster drop in filling pressure than nitroglycerin; no significant breathlessness difference vs nitroglycerin. R2
- Human ASCEND-HF: missed its significance thresholds; no effect on death or rehospitalization. R3
Is it safe?
- Human Higher rates of hypotension. R3
Gray-market vials: extra risks
A gray-market vial has no quality control and no guarantee of identity, strength or sterility. We test retail vials blind under the Open Peptide Standard; see /tests/. A passing test covers one batch on one date and does not mean the compound is safe.
Is it legal?
- US: FDA-approved, listed discontinued. R1
- Compounding: not on FDA's 503A or 503B bulk-substance category lists and not on FDA's compounding safety-risk page. R5, R6, R7
- Sport: not named on WADA's 2026 Prohibited List. R8
Study details
Study details
These are amounts researchers used, not recommendations.
| Study | People / model | Route | Amount used | Follow-up | Reported | Citation |
|---|---|---|---|---|---|---|
| VMAC 2002 | 489 inpatients, decompensated CHF | IV | Per study | 3–24 hours | PCWP −5.8 mm Hg at 3 h | PMID 11911755 |
| ASCEND-HF 2011 | 7,141 acute HF | IV | Per study | 24–168 h; 30-day outcome | Death/rehosp 9.4% vs 10.1% | PMID 21732835 |
Full reference list (PubMed, CT.gov, FDA and WADA checked Oct 26, 2026)
- R1 Drugs@FDA, Natrecor (nesiritide), listed discontinued, application NDA020920 (openFDA drugsfda record checked Oct 26, 2026). https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=NDA020920
- R2 Publication Committee for the VMAC Investigators (Vasodilatation in the Management of Acute CHF). JAMA. 2002. PMID 11911755
- R3 O'Connor CM, et al. N Engl J Med. 2011. PMID 21732835
- R4 ClinicalTrials.gov NCT00475852, ASCEND-HF, Scios, completed (CT.gov API v2, checked Oct 26, 2026). https://clinicaltrials.gov/study/NCT00475852
- R5 FDA, 503A bulk drug substances categories list (updated May 14, 2026). https://www.fda.gov/media/94155/download
- R6 FDA, 503B bulk drug substances categories list (updated Mar 21, 2025). https://www.fda.gov/media/94164/download
- R7 FDA, Certain bulk drug substances for use in compounding that may present significant safety risks (content current Apr 22, 2026). https://www.fda.gov/drugs/human-drug-compounding/certain-bulk-drug-substances-use-compounding-may-present-significant-safety-risks
- R8 WADA. The 2026 Prohibited List, full list checked; compound not named. https://www.wada-ama.org/sites/default/files/2025-09/2026list_en_final_clean_september_2025.pdf
Disclaimer
This page is for education and harm reduction, not medical advice or a recommendation to use Nesiritide (Natrecor). This is a prescription medicine. Use it only under the care of a licensed clinician; do not buy it from research-chemical or gray-market sellers. Report problems to FDA MedWatch (https://www.fda.gov/safety/medwatch).