Nerinetide (NA-1)_Dosage, benefits & legal status
Also known as NA-1, Tat-NR2B9c, FN-023
A 20-residue peptide built to stop nerve cells dying during a stroke. Over 2,400 patients later, the main results are neutral.
Common vial size is what vendors typically sell, not a recommendation. Enter your own vial in the calculator.
What is Nerinetide (NA-1)?
Plain language first. The technical label stays, but it never stands alone.Overview
It was meant to buy brain cells time while a blocked artery is reopened. In ESCAPE-NA1 (1,105 people) it did no better than placebo overall, but looked helpful in people not given the clot-buster alteplase. ESCAPE-NEXT then tested exactly those people and found 45% against 46% independent at 90 days. It is not approved anywhere.
Nerinetide (NA-1, Tat-NR2B9c) joins the 11-residue cell-entry segment of the HIV Tat protein to the last nine residues of the NMDA receptor's GluN2B subunit. Inside nerve cells, that tail occupies the scaffold protein PSD-95 and uncouples the receptor from the enzyme that makes toxic nitric oxide during a stroke. Michael Tymianski's Toronto lab designed it, and his company NoNO develops it.
What it's used for
Not available. A trial drug for acute ischaemic stroke, given once by infusion; all three large trials missed their primary endpoints.
How does Nerinetide (NA-1) work?
What it does in the body, and where.Nerinetide is a decoy: the tail of an NMDA receptor carried into nerve cells by a cell-penetrating segment.
- 01Glutamate overloadIn a stroke, glutamate floods NMDA receptors. PSD-95 holds those receptors next to nitric oxide synthase, so the calcium rush drives a burst of toxic nitric oxide.
- 02Getting inResidues 1 to 11, borrowed from the HIV Tat protein, carry the peptide across the blood-brain barrier and into nerve cells.
- 03UncouplingResidues 12 to 20, ending in the ESDV motif, sit in PSD-95's docking pocket so the receptor is no longer linked to the enzyme. The receptor channel still works. Rats and macaques given it after an induced stroke had smaller strokes.
A schematic of the compound's mechanism, not a diagnostic image.
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.
ESCAPE-NA1
tested-and-failed- Human trial1,105 people having clot retrieval: 61.4% against 59.2% independent at 90 days, not significant.
- Human trialWithout alteplase, 59.4% against 49.8%; with it, 62.7% against 65.7%. Alteplase cut nerinetide levels by about 60%.
ESCAPE-NEXT
tested-and-failed- Human trial850 people having clot retrieval with no thrombolysis, the group that looked best before: 45% against 46% independent at 90 days.
- No dataDeaths 19.2% against 17.7%. The arms were 454 against 396 despite planned 1:1 allocation, unexplained in the sources.
FRONTIER
tested-and-failed- Human trialParamedics gave it in the ambulance a median 64 minutes after onset; 57% against 58% good outcome.
- No dataAn exploratory benefit appeared in patients who did get thrombolysis, the opposite of the ESCAPE-NA1 pattern.
ESCAPE-NA1 is often described as showing benefit without alteplase; that was a subgroup, and ESCAPE-NEXT, built to confirm it, did not (45% against 46%). ESCAPE-NEXT enrolled 850, not 1,020. ENACT is cited as proof of neuroprotection, but its registered primary endpoint, lesion volume, was not significant; only lesion counts favoured it. FRONTIER's benefit signal was in patients given thrombolysis, against the plasmin explanation. The pooled early-window and one-year analyses are post hoc and led by the developer, whose founder holds company stock. Half-life figures of 5 to 10 and 6 to 15 minutes both appear in the same protocol.
The published record
Papers and trials about Nerinetide (NA-1)
73 papers tagged human · 52 not reviews or lab · 26 clinical trial publications
3 registered trials · 2 with posted results
Furthest stage reached: Phase 3, results posted
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 Nerinetide (NA-1)
Evidence
Investigational
Category
Healing and recovery
Common vial
Varies
Half-life
Minutes (about 5 to 15)
How much, and do you cycle it?
The range, and whether you take breaks.2.6 mg/kg once, up to 270 mg (trials), a single dose. A single dose Trial dose
One infusion at the time of the stroke; not repeated.
How long does it stay in the body?
The half-life, and where the figure comes from.Minutes (about 5 to 15)Trial protocol
The protocol gives 6 to 15 minutes in one section and 5 to 10 in another. It is cleared from blood quickly, and plasmin generated by alteplase breaks it down further.
Source: ESCAPE-NEXT protocol, sections 2.1.1 and 4.3
You can compare this against the whole library to see where it sits.
How do I dose and price it?
Enter your vial and your dose. Pick a mix. We show the draw and the cost.The vial holds a fixed amount of drug. Adding more water does not make more drug, it just spreads it thinner, so you draw a bigger number on the syringe for the same dose.
A single 2.6 mg/kg intravenous infusion over 10 minutes, capped at 270 mg, from a 20 mg/mL vial. In ESCAPE-NEXT it was given within 12 hours of onset to people not receiving clot-dissolving drugs; in FRONTIER, by paramedics within 3 hours. Trial-only; the vial calculator does not apply.
How do you store it?
Before mixing, and after.Dry powder in the freezer or fridge. Once mixed, fridge, and use within about a month.
Unmixed lyophilized Nerinetide (NA-1) keeps for a long time cold. Once you add water the clock starts: most reconstituted vials hold up for roughly 28 to 30 days at fridge temperature. Keep it out of light, and do not freeze it after mixing.
What are the side effects and cautions?
Known cautions and warnings for this compound.Solubility, computed: 65% charged residues, 15% 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
- Alteplase given before it: plasmin made by alteplase cuts nerinetide's blood levels by about 60%
- Low blood pressure, since its main side effect is a histamine-driven fall in blood pressure
- Pregnancy or breastfeeding, with no data
- Use outside a trial: it is not made or sold commercially
Stop and get help
- Dizziness, fainting, flushing or a racing heart during or soon after the infusion
- Swelling of the face or throat, wheezing or trouble breathing
Common effects
- Serious low blood pressure in 1.3% against 0.2% on placebo in ESCAPE-NA1
- Low blood pressure of any severity in about 11 to 12% against 9 to 10%
- Headache in 11.5% against 6.6% in ESCAPE-NEXT
- Deaths at 90 days 11.7% against 13.3% in ESCAPE-NA1 and 19.2% against 17.7% in ESCAPE-NEXT
Where this page says nothing is established, that means nobody has studied it, not that a compound is safe.
Is Nerinetide (NA-1) approved?
And where the numbers on this page come from.No. Nerinetide (NA-1) is not approved anywhere and is currently in company-run clinical trials. There is no legal route to obtain it outside a trial.
- Approval statusInvestigational
- RouteInto a vein (10-minute infusion), trial only
- Checked13 October 2026
- DoseFrom published clinical trials. Not approved by a regulator for this dose.
- Vial sizeFrom what vendors typically list; not a recommendation.
- SourcesHill MD et al., Lancet 2020;395:878-887 (ESCAPE-NA1)ClinicalTrials.gov, ESCAPE-NA1 posted results (NCT02930018)Hill MD et al., Lancet 2025;405:560-570 (ESCAPE-NEXT)ClinicalTrials.gov, ESCAPE-NEXT posted results (NCT04462536)Christenson J et al., Lancet 2025;405:571-582 (FRONTIER)Hill MD et al., Lancet Neurology 2012;11:942-950 (ENACT)Tymianski M et al., Lancet Neurology 2025;24:208-217 (pooled early-window analysis)ESCAPE-NEXT protocol and statistical analysis planFDA GSRS substance record, nerinetide (UNII D45TI2TWMA)Aarts M et al., Science 2002;298:846-850TCTMD, 'Another neuroprotective agent fails in acute stroke, or does it?' (2020)
What has happened recently
Not approved anywhere, and no application has been filed. The FDA granted orphan designations for subarachnoid haemorrhage (May 2013) and for acute ischaemic stroke within 3 hours of onset (April 2014). ESCAPE-NA1 (NCT02930018), FRONTIER (NCT02315443) and ESCAPE-NEXT (NCT04462536) all missed their primary endpoints; ESCAPE-NEXT was published in February 2025. The investigators have since argued for a new trial limited to patients treated within 3 hours, based on post-hoc analyses. NoNO's successor compound NoNO-42, designed to work alongside clot-dissolving drugs, entered phase 1 in 2022.
You can compare this against the whole library, or read how to check a seller.
What else is like Nerinetide (NA-1)?
Others in Healing and recovery, side by side.If you're weighing Nerinetide (NA-1), it's worth reading Pentosan Polysulfate (PPS), Plecanatide (Trulance), and Redasemtide in the same class.
A 20-residue peptide built to stop nerve cells dying during a stroke. Over 2,400 patients later, the main results are neutral.
- Dose
- 2.6 mg/kg once, up to 270 mg (trials)
- How often
- A single dose
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- Dose
- 300 mg per day (100 mg three times a day)
- How often
- Three times a day (oral)
A daily constipation tablet that works inside the gut and barely reaches the blood.
- Dose
- 3 mg once daily (label)
- How often
- Once daily, with or without food
An experimental IV peptide meant to recruit your own stem cells, tested in skin disease, stroke and liver disease.
- Dose
- 0.75 to 1.5 mg/kg daily for 5 days, or weekly (trial doses)
- How often
- Daily for 5 days, or weekly for 4 weeks (trials)
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.
- How to Read a Peptide COA
What the purity number does and does not tell you, and how to spot an edited report.
- How to Vet a Peptide Vendor
Independent COAs, HPLC purity, and the red flags that mean walk away.
Sources
- Hill MD et al., Lancet 2020;395:878-887 (ESCAPE-NA1)(2020)1,105 people having clot retrieval: independent at 90 days 61.4% against 59.2%, adjusted RR 1.04 (0.96 to 1.14). Without alteplase: 59.4% against 49.8%, RR 1.18 (1.01 to 1.38).
- ClinicalTrials.gov, ESCAPE-NA1 posted results (NCT02930018)(2020)Serious hypotension 7 of 547 against 1 of 554; with alteplase 62.7% against 65.7% independent.
- Hill MD et al., Lancet 2025;405:560-570 (ESCAPE-NEXT)(2025)850 people having clot retrieval without thrombolysis: 45% against 46% independent at 90 days, OR 0.97 (0.72 to 1.30), p=0.82.
- ClinicalTrials.gov, ESCAPE-NEXT posted results (NCT04462536)(2025)Deaths 19.2% against 17.7%; low blood pressure 12.0% against 9.2%; headache 11.5% against 6.6%.
- Christenson J et al., Lancet 2025;405:571-582 (FRONTIER)(2025)Paramedic-given within 3 hours, 507 analysed: 57% against 58% good outcome, adjusted OR 1.05 (0.73 to 1.51). Exploratory benefit in those given thrombolysis.
- Hill MD et al., Lancet Neurology 2012;11:942-950 (ENACT)(2012)185 people after aneurysm repair: lesion volume not different (primary); fewer new lesions, rate ratio 0.53.
- Tymianski M et al., Lancet Neurology 2025;24:208-217 (pooled early-window analysis)(2025)Post hoc, 690 of 2,487 patients treated within 3 hours and selected for reperfusion: 56% against 48% good outcome, adjusted OR 1.48.
- ESCAPE-NEXT protocol and statistical analysis plan(2020)2.6 mg/kg up to 270 mg over 10 minutes; 20-residue peptide; half-life in minutes; hypotension from a transient histamine rise; plasmin cleavage rationale.
- FDA GSRS substance record, nerinetide (UNII D45TI2TWMA)(2026)Sequence YGRKKRRQRRRKLSSIESDV, no modifications; CAS 500992-11-0; MW 2519.
- Aarts M et al., Science 2002;298:846-850(2002)First description of Tat-NR2B9c: uncoupling NMDA receptors from PSD-95 reduced stroke damage in rats.
- TCTMD, 'Another neuroprotective agent fails in acute stroke, or does it?' (2020)(2020)Treatment-by-alteplase interaction p=0.033; independent experts cautioned against reading the subgroup as proof.
Beyond these, 159 records are indexed. Browse the records