Carperitide_Dosage, benefits & legal status
Also known as human ANP, alpha-hANP, hANP, atrial natriuretic peptide (1-28), recombinant human atrial natriuretic peptide
The A in the natriuretic alphabet, and the only one of the three routinely given to patients anywhere. The evidence behind that use is thinner than its 30 years on the market suggest.
Common vial size is what vendors typically sell, not a recommendation. Enter your own vial in the calculator.
What is Carperitide?
Plain language first. The technical label stays, but it never stands alone.Overview
Where nesiritide is a copy of BNP from the heart's ventricles, carperitide is a copy of ANP from the atria. It is given as a continuous drip in Japanese hospitals for acute heart failure, approved there since 1995. The one trial built to test whether adding it to standard care changes long-term outcomes enrolled 247 patients, stopped early, and found no difference in death or readmission over two years. Pooled observational data go further and point the wrong way.
Carperitide is a synthetic copy of human atrial natriuretic peptide, the 28-residue hormone the heart's atria release when they are stretched. It acts at the NPR-A receptor, raising cyclic GMP to widen blood vessels and increase sodium and water excretion. It is used for acute heart failure in Japan and has never been FDA approved.
What it's used for
Acute heart failure, as a continuous intravenous infusion, in Japan. It is not approved in the United States.
How does Carperitide work?
What it does in the body, and where.ANP is the heart's own pressure-release signal. When the atria are stretched by too much volume, they release it, and it tells the vessels to relax and the kidney to let go of salt and water.
- 01Giving the hormone the failing heart is already makingPeople in acute heart failure have high natural ANP and BNP levels already, because the heart is stretched. The idea behind every drug in this family is that the natural response is not strong enough, so more of it should help.
- 02NPR-A and cyclic GMPCarperitide binds NPR-A, a receptor that is itself an enzyme. Switching it on makes cyclic GMP inside the cell, relaxing vessel walls and pushing sodium out through the kidney.
- 03Why the kidney result mattersThe hope was that unloading the heart would protect the kidney. In the randomized trial, kidney filtration fell further on carperitide than on standard care alone. That is the recurring problem with this family: the pressure drop that unloads the heart can also reduce flow through the kidney.
What else is it used for?
Each group carries its own evidence level.Approved means regulators have cleared it for that purpose. Investigational means it is in trials. Early research means it is being studied and is not established.
The randomized Japanese trial
peer-reviewed-human- Human trial247 patients across nine Japanese hospitals, 122 given low-dose carperitide on top of standard care and 125 given standard care with carperitide withheld for 72 hours.
- Human trialDeath or heart failure hospitalization within two years: 29.5% against 28.0%, hazard ratio 1.26 with a confidence interval from 0.78 to 2.06, at P = 0.827.
- Human trialDeaths alone went the other way, 6 against 11, and heart failure hospitalizations went the first way, 34 against 29. Neither was significant and the confidence intervals are wide in both directions.
- Human trialUrine volume and breathlessness at 72 hours showed no significant difference, and neither did BNP, renin, aldosterone or catecholamines.
- Human trialKidney filtration fell further on carperitide, by 3.9 mL/min/1.73 m2 more than on standard care, with a confidence interval that excludes no effect.
What the pooled data say
Early research- ReviewA 2025 meta-analysis pooled nine studies, four randomized and five propensity-matched, and found in-hospital mortality odds of 1.38 (95% CI 1.07 to 1.78) at P = 0.01 against non-carperitide treatment. That is the wrong direction.
- No dataThe randomized trials alone gave 0.85 with a confidence interval from 0.07 to 10.49, settling nothing in either direction. The significant result comes from the non-randomized studies.
- No dataDropping two nationwide propensity-matched studies made the difference disappear, and the authors urge caution on that basis. Heterogeneity across the nine studies was 77%.
- ReviewNo significant difference showed up in long-term mortality, heart failure rehospitalization or hypotension. The authors conclude that carperitide may not be superior to treatment without it.
How much that trial can settle
peer-reviewed-human- No dataThe authors say it plainly: enrollment was stopped early, so the study was underpowered and inconclusive. A trial that is underpowered cannot show a benefit is absent, only that this one did not find one.
- No dataIt tested a deliberately low dose added to standard care, not the doses used in routine Japanese practice, so it does not describe how the drug is normally given.
- No dataCarperitide has been marketed in Japan since 1995, far longer than this trial, and most of the evidence behind that use is observational rather than randomized. One pooled analysis counted 30,665 patients across six observational studies against this trial's 247.
The LASCAR-AHF result is quoted in both directions and supports neither. It did not show carperitide works, and because enrollment stopped early and the authors call the study underpowered and inconclusive, it did not show carperitide fails either. The pooled observational mortality signal is a separate matter and points the wrong way, though it rests on non-randomized data and vanishes when two large studies are removed. The 29.5% against 28.0% figures come from 247 patients. Carperitide is also not the same as nesiritide: this is A-type natriuretic peptide from the atria, nesiritide is B-type from the ventricles, and they are different sequences from different genes. The dose quoted on this page is the trial's deliberately low one, not a Japanese prescribing dose.
The published record
Papers and trials about Carperitide
236 papers tagged human · 193 not reviews or lab · 43 clinical trial publications
3 registered trials · none with posted results
Furthest stage reached: Approved outside the US, Japan
Counted from Europe PMC indexing, not read by a person; a human tag can land on reviews, commentary or lab papers; clinical trial publications is the narrower count.
At a glance
Four things to know about Carperitide
Evidence
Clinical use
Category
Sexual and hormonal
Common vial
Varies
Half-life
Minutes, so it is infused
How much, and do you cycle it?
The range, and whether you take breaks.0.1 micrograms per kilogram per minute on the Japanese label; the trial tested 0.02, continuous infusion while in the hospital. Continuous while in the hospital Trial dose
Given as an uninterrupted infusion for as long as the episode is being treated in the hospital. The trial used 72 hours. There is no cycle and no home use.
Minutes, so it is infusedNo figure
Natural ANP clears from blood within a few minutes, and carperitide is the same molecule, so it is given as a continuous drip rather than as injections. No specific figure is quoted here because none was read from a primary source.
You can compare this against the whole library to see where it sits.
How is it given?
Dosing context and source notes.Given in hospital from a prepared product, so there is nothing to mix.
Trial range: 0.1 up to 0.2 mcg/kg/min per dose. HANP for Injection 1000, Japanese prescribing record, PMDA
How do you store it?
Before mixing, and after.Given in a hospital or trial clinic, so the pharmacy stores it.
Carperitide goes into a vein and is prepared by hospital, clinic or trial pharmacy staff, following the product label or the trial protocol. Some products like this are ready-made solutions and others are powders mixed just before use, often with hours rather than weeks of shelf life once prepared. It is not a medicine people store at home.
What are the side effects and cautions?
Known cautions and warnings for this compound.Solubility, computed: 29% charged residues, 32% hydrophobic. Water usually sufficient.
A first-pass rule from peptide manufacturers' guidance. It does not account for disulfide bridges, salt form or how the powder was dried, and it predicts what should be easy rather than what will happen in your vial.
Who should avoid it
- Any use outside a hospital setting: it is a titrated continuous infusion managed by clinical staff
- Use in the United States, where it has no FDA approval and no legal supply
- Anything sold as a research powder under this name: the medicine is a sterile hospital infusion
Stop and get help
- Not applicable outside a hospital setting, where the team manages blood pressure and kidney function during the infusion
Common effects
- Falling blood pressure, the thing the infusion rate is titrated against
- A measurable fall in kidney filtration during treatment
Where this page says nothing is established, that means nobody has studied it, not that a compound is safe.
Is Carperitide approved?
And where the numbers on this page come from.Not in the United States. Carperitide has no FDA approval. It is approved in Japan.
- Approval statusClinical use
- RouteInto a vein (continuous infusion), in the hospital
- Checked24 October 2026
- Approved outside the USJapan: Approved in Japan as HANP for Injection 1000, marketed by Daiichi Sankyo since May 1995 under approval number 20700AMZ00027, for acute heart failure including the acute worsening of chronic heart failure. The Japanese label gives 0.1 micrograms per kilogram per minute, rising to 0.2 under hemodynamic monitoring. The original approval date is not published on the regulator's record. It has never been FDA approved in the United States.This does not change the United States position above.
- DoseFrom published clinical trials. Not approved by a regulator for this dose.
- Vial sizeFrom what vendors typically list; not a recommendation.
- SourcesFDA GSRS substance record, carperitide (UNII GZ8FA500J0)UniProtKB entry P01160, the natriuretic peptides A precursorHANP for Injection 1000, Japanese prescribing record, PMDAShiga et al., meta-analysis of carperitide in acute heart failure, BMC Cardiovascular Disorders, 2025Honda et al., LASCAR-AHF, European Heart Journal: Acute Cardiovascular Care, 2025
What has happened recently
Not FDA approved, and approved in Japan. Japan's regulator lists it as HANP for Injection 1000, marketing authorization held by Daiichi Sankyo under approval number 20700AMZ00027, with marketing beginning in May 1995, for acute heart failure including the acute worsening of chronic heart failure. The Japanese label gives 0.1 micrograms per kilogram per minute as a continuous intravenous infusion, rising to 0.2 under hemodynamic monitoring. The original approval date is not published on that record, so it is not stated here. Identity is settled: FDA substance record UNII GZ8FA500J0, International Nonproprietary Name 6699, US adopted name QQ-59, CAS 85637-73-6. The randomized trial is registered in Japan as UMIN000013819 rather than on ClinicalTrials.gov.
You can compare this against the whole library, or read how to check a seller.
What else is like Carperitide?
Others in Sexual and hormonal, side by side.If you're weighing Carperitide, it's worth reading Cenderitide, PT-141 (Bremelanotide), and Kisspeptin in the same class.
The A in the natriuretic alphabet, and the only one of the three routinely given to patients anywhere. The evidence behind that use is thinner than its 30 years on the market suggest.
- Dose
- 0.1 micrograms per kilogram per minute on the Japanese label; the trial tested 0.02
- How often
- Continuous infusion while in the hospital
A designed chimera rather than a copy of anything the body makes. The engineering is the interesting part.
- Dose
- No established dose
- How often
- Not established
An approved shot that boosts sexual desire through the brain.
- Dose
- 1.75 mg per dose
- How often
- As needed, before activity
A peptide that switches on natural sex-hormone signaling for libido and fertility.
- Dose
- 0.1 up to 0.2 mg per dose
- How often
- Daily in vendor protocols
Guides for this compound
- How to Reconstitute a Peptide
Mix peptide powder with bacteriostatic water, step by step.
- How to Read an Insulin Syringe
Read the units, convert to millilitres, and draw the exact dose.
- mcg vs mg: The Peptide Dosing Mistake to Avoid
Your vial says mg and your protocol says mcg. Here is the conversion and how to check it.
Sources
- FDA GSRS substance record, carperitide (UNII GZ8FA500J0)(2026)Protein record, 28 residues, one disulfide bond joining cysteines 7 and 23. International Nonproprietary Name 6699, US adopted name QQ-59, CAS 85637-73-6.
- UniProtKB entry P01160, the natriuretic peptides A precursor(2026)Annotates atrial natriuretic peptide as residues 124 to 151 of the precursor. A positional read gives Ser-Leu-Arg-Arg at 124 to 127, matching the GSRS sequence.
- HANP for Injection 1000, Japanese prescribing record, PMDA(2026)Brand HANP for Injection 1000, generic carperitide (genetical recombination), marketing authorization holder Daiichi Sankyo, approval number 20700AMZ00027, marketing from May 1995. Indication: acute heart failure, including the acute worsening of chronic heart failure. Dose: 0.1 micrograms per kilogram per minute as a continuous intravenous infusion, rising to 0.2 under hemodynamic monitoring. The original approval date is not given.
- Shiga et al., meta-analysis of carperitide in acute heart failure, BMC Cardiovascular Disorders, 2025(2025)Volume 25, article 896, published November 27, 2025. Nine studies pooled: four randomized trials and five propensity-matched. In-hospital mortality odds ratio 1.38 (95% CI 1.07 to 1.78) at P = 0.01 with heterogeneity of 77%, favoring non-carperitide treatment. Randomized trials alone gave 0.85 (95% CI 0.07 to 10.49), not significant. No significant difference in long-term mortality, heart failure rehospitalization or hypotension. Removing two nationwide propensity-matched studies eliminated the difference, and the authors urge caution.
- Honda et al., LASCAR-AHF, European Heart Journal: Acute Cardiovascular Care, 2025(2025)Volume 14, issue 2, pages 83 to 92, published online December 4, 2024. 247 patients at nine Japanese sites, 122 on low-dose carperitide at 0.02 mcg/kg/min for 72 hours plus standard care against 125 on standard care alone. Primary outcome of death or heart failure hospitalization within 2 years: 36 of 122 against 35 of 125, hazard ratio 1.26 (95% CI 0.78 to 2.06), P = 0.827. The authors state that enrollment was terminated prematurely and the study was underpowered and inconclusive.
Beyond these, 310 records are indexed. Browse the records