Natriuretic Peptide (ANP) dosing & administration

Honda S, Nagai T, Honda Y, et al. · 2025

Low-dose carperitide provided rapid hemodynamic improvements in acute heart failure patients but did not reduce long-term mortality or hospitalization when combined with standard treatment. The natriuretic peptide was most beneficial for immediate symptom relief.

Inamoto M, Kohyama N, Suzuki H, et al. · 2024

Patients under 75 years without prior diuretic use achieved the best diuretic response to carperitide, with 53.6% showing excellent results. Administering carperitide within 2 hours of a diuretic maximized urine output compared to longer delays.

Gorący-Rosik A, Fic M, Rosik J, et al. · 2025

Genetic variations in NPPA and NPPB genes predicted natriuretic peptide response and heart failure severity. These polymorphisms influenced ANP production and therapy effectiveness, supporting future personalized medicine approaches.

Nogi K, et al. · 2022

Potter LR, Yoder AR, Flora DR, Antos LK, Dickey DM · 2009

ANP is the 28-amino-acid peptide cleaved from proANP stored in atrial granules and released on atrial stretch from increased intravascular volume. It binds natriuretic peptide receptor-A, a transmembrane guanylyl cyclase that raises cGMP; NPR-A-dependent falls in blood pressure are achieved through natriuresis and diuresis, vasorelaxation, increased endothelial permeability and antagonism of the renin-angiotensin system, and ANP/NPR-A signalling also inhibits cardiac hypertrophy and remodelling. Plasma half-life of ANP in humans is approximately 2 min. Receptor dephosphorylation is the mechanism of desensitisation after prolonged ANP exposure. Synthetic full-length ANP, carperitide, was approved in Japan in 1995 for acute decompensated heart failure; in the United States clinical use of BNP rather than ANP was pursued.

Yandle TG, Richards AM, Nicholls MG, Cuneo R, Espiner EA, Livesey JH · 1986

After an intravenous bolus of 100 micrograms of alpha-human ANP in normal men, immunoreactive alpha-hANP fell exponentially over the first 10 min with t1/2 = 2.5 min and reached basal values by 30 min. Metabolic clearance rate during steady-state infusion was 2.4 L/min, volume of distribution 10.7 L, and the rapid-phase disappearance rate after stopping infusion 3.1 min.

de Bold AJ, Borenstein HB, Veress AT, Sonnenberg H · 1981

Intravenous injection of atrial, but not ventricular, myocardial extract produced a rapid and potent increase in renal sodium and water excretion in rats - the observation from which atrial natriuretic peptide was identified.

Nomura F, Kurobe N, Mori Y, Hikita A, Kawai M, Suwa M, Okutani Y · 2008

Prospective observational study of 1,832 acute heart failure syndrome patients with pulmonary congestion, dyspnoea and preserved systolic blood pressure treated with carperitide (alpha-human atrial natriuretic peptide) monotherapy, started at 0.025-0.05 microg/kg/min in 50.4%. Carperitide monotherapy restored the acute phase and improved the degree of dyspnoea on the modified Borg scale in 1,524 patients (83.2%). Adverse drug reactions occurred in 4.64%, most frequently hypotension (3.55%).

Suwa M, Seino Y, Nomachi Y, Matsuki S, Funahashi K · 2005

Six-year open-label registry of 3,777 acute heart failure patients treated with carperitide (alpha-human atrial natriuretic peptide) at a median 0.085 microg/kg/min for a median 65 h (interquartile 22-142 h); 82% were clinically improved. Adverse events occurred in 16.9%, the most frequent being blood pressure lowering (9.5%), which occurred in the first 3 h of infusion, with 96% of patients recovering or improving without specific treatment. Renal function disturbance, low blood pressure, age and Killip class predicted 7-day mortality.

Daiichi Sankyo / Pharmaceuticals and Medical Devices Agency (PMDA) · 2026

Approved in Japan for acute heart failure including acute exacerbation of chronic heart failure. Given as continuous intravenous infusion of 0.1 microg/kg/min, adjustable up to 0.2 microg/kg/min according to haemodynamics, with the patient monitored for blood pressure, heart rate, urine output, electrolytes and where possible pulmonary capillary wedge pressure, right atrial pressure and cardiac output; if haemodynamics and symptoms have not begun to improve 60 min after starting, another treatment should be used. Adverse reactions include blood pressure decrease 8.6%, hypotensive shock 0.2%, bradycardia 0.2%, electrolyte abnormality from excessive diuresis 1.8%, ventricular tachycardia 0.2%, ventricular fibrillation 0.1%, thrombocytopenia 0.1%, and (frequency not specified) nausea/vomiting, dizziness, flushing, atrial fibrillation and supraventricular tachycardia, raised BUN and creatinine, urticaria, rash and pruritus, and phlebitis at the injection site. Elimination half-life during 0.1 microg/kg/min infusion is 2.8 min (alpha phase) and 25.3 min (beta phase).

Hattori H, Minami Y, Mizuno M, et al. · 2012

Thirty-eight acute heart failure syndrome patients received 48-h continuous infusion of carperitide (0.0125-0.05 microg/kg/min) or nicorandil. After 48 h, systolic blood pressure fell 22.1 +/- 20.0% with carperitide versus 5.3 +/- 10.4% with nicorandil (P = 0.003), and improvement in estimated pulmonary capillary wedge pressure was greater with carperitide (38.2 +/- 14.5% vs 26.5 +/- 18.3%, P = 0.036), while improvement in estimated cardiac output was greater with nicorandil (52.1 +/- 33.5% vs 11.4 +/- 36.9%, P = 0.001).

Kajimoto K, Sashida Y, Minami Y, Yumino D, Kawarai H, Kasanuki H · 2009

In 24 patients with acute decompensated heart failure and left ventricular systolic dysfunction studied by right heart catheterisation, 17 (71%) responded to initial carperitide therapy with a 30% or greater fall in pulmonary capillary wedge pressure, or a fall below 16 mmHg, within 6 h of starting the infusion. Admission systolic blood pressure (cut-off 120 mmHg) and cardiac index predicted the response.

Kawase Y, Kadota K, Tada T, et al. · 2015

In 205 patients (mean age 75.6 years) hospitalised for acute decompensated heart failure and treated with low-dose carperitide (0.01-0.05 microg/kg/min), worsening renal function - a rise in serum creatinine of 0.3 mg/dl or more from admission - occurred within the first 24 h in 14 patients (7%). Independent predictors were hypotension (systolic blood pressure below 90 mmHg) within 12 h and serum creatinine on admission. Among patients with eGFR below 60 ml/min/1.73 m2, worsening renal function was more frequent when hypotension occurred (22.6% vs 4.4%).

Ayaz Z, Alsarkhi LN, Rawat A, et al. · 2025

Meta-analysis of six studies (2008-2025) of carperitide versus control in heart failure. All-cause mortality risk ratio 1.02 (95% CI 0.63-1.66), heart failure hospitalisation risk ratio 0.98 (95% CI 0.85-1.14). Carperitide received regulatory approval for acute heart failure in Japan in 1995, but adoption has remained geographically limited because of mixed efficacy results and the absence of large randomised trials meeting regulatory requirements in Western countries.