Ularitide dosing & administration
A synthetic natriuretic peptide designed to help your heart pump better and remove excess fluid when you need it most.
Written by Michael Carroll — Owner, Director of Research · Reviewed by the Peptide Initiative Research Team · Editorial standards
Dosing
How much do I take?
Intravenous infusion: Delivered straight into a vein through a drip (IV), done by a clinician.
Bioavailability Complete (about 100%) — delivered straight into the bloodstream.
15 ng/kg/min
Frequency
Continuous infusion
Duration
48 hours
Dose and duration used in the TRUE-AHF trial (2157 patients) for acute heart failure; infusion reduced or stopped for systolic BP <100 mmHg [6]. Investigational only — not an approved drug.
Timing
Best time to take
Ularitide is administered intravenously in a clinical setting. [6][10] Timing is determined by your healthcare provider based on the treatment protocol and your medical needs.
With food?
IV administration of Ularitide is not dependent on meal timing. Your healthcare team will provide specific instructions regarding food and fluid intake around treatment sessions.
If stacking
Ularitide should be used as directed by your healthcare provider. If combining with other medications or supplements, discuss potential interactions with your provider. Avoid combining with compounds that have overlapping mechanisms unless specifically guided by a medical professional.
Adjusting your dose
Increase if
- You've tolerated the current dose for the recommended period without significant side effects
- Therapeutic goals haven't been met at the current dose level
- Your healthcare provider recommends dose escalation based on your response
- Lab work or clinical assessments support a higher dose
Decrease if
- Side effects are bothersome or impacting daily life despite management strategies
- You experience any signs of an adverse reaction
- Lab results indicate the need for dose reduction
- Your healthcare provider recommends a lower dose based on your response
Signs of right dose
- Therapeutic goals being met with minimal side effects
- Stable and consistent response to treatment
- Lab values or clinical markers trending in the right direction
- Good tolerance with manageable or absent side effects
Administration
How do I use it?
Reconstitution
What you need
Injection
Route
Subcutaneous injection (into the fatty tissue just under the skin)—allows for consistent absorption and can be self-administered at home after proper training
Best sites
Storage
Before reconstitution
Store Ularitide in the refrigerator at 36-46°F (2-8°C) in its original packaging. Protect from light and moisture. Do not freeze. Check the expiration date before use. Some formulations may be stored at room temperature for limited periods—check your specific product labeling.
After reconstitution
Once reconstituted, Ularitide should be kept refrigerated at 36-46°F (2-8°C) and used within the timeframe specified on your product labeling (typically 14-28 days). Label the vial with the reconstitution date. Do not use if the solution appears cloudy, discolored, or contains particles.
Signs of degradation — discard the vial
Sample daily schedule
As prescribed (once daily)
As prescribed by your healthcare provider injection
Site: Intravenous infusion—rotate sites if applicable
Maintain a consistent schedule for optimal results with Ularitide. Set reminders if needed. If you miss a dose, follow your healthcare provider's instructions—do not double up on doses to compensate.
Safety
Is it safe?
Side effects
Commonly reported: Dizziness or lightheadedness, Low blood pressure (hypotension), Headache, Nausea
Less common: Elevated potassium levels, Worsening kidney function (transient), Allergic reactions at injection site, Chest discomfort, Irregular heartbeat (arrhythmia)
Stop and seek help if
- Severe or worsening side effects that don't improve with dose adjustment or supportive care
- Signs of an allergic reaction—rash, hives, swelling, or difficulty breathing
- Your healthcare provider recommends discontinuation based on your clinical response
- Development of any new medical condition that may be contraindicated with Ularitide
- Pregnancy or planning to become pregnant (unless specifically approved for use during pregnancy)
- Abnormal lab results or clinical markers that suggest adverse effects
Ularitide should only be started, adjusted, or discontinued under medical supervision. This information is for educational purposes only and does not replace professional medical advice. Never stop a prescribed treatment without consulting your healthcare provider first, as abrupt discontinuation may have consequences.
Flagged pairings
- Vasoconstrictors — Directly oppose ularitide's mechanism; could cause dangerous blood pressure swings
- NSAIDs — Can reduce natriuretic peptide effectiveness and increase kidney injury risk
- Certain Antiarrhythmics — May increase hypotension risk when combined with ularitide
Published research
What the studies show
Mitrovic V, Forssmann WG, Schnitker J · 2018
Meta-analysis of 12 randomized controlled trials showed ularitide produced stronger improvements in pulmonary pressure and heart function compared to other vasoactive drugs. After just 6 hours of treatment, ularitide demonstrated significantly better hemodynamic results than placebo and other vasodilator treatments for acute heart failure patients.
Anker SD, Ponikowski P, Mitrovic V, Peacock WF, Filippatos G · 2015
Comprehensive review documenting ularitide's development from laboratory research to human clinical trials. The natriuretic peptide showed promising results in early studies, establishing the scientific foundation and clinical evidence needed for its evaluation in larger Phase 3 trials for acute heart failure treatment.
Haryani A, Sangwan A · 2024
Recent 2024 review examined ularitide alongside other newer heart failure medications like vericiguat and serelaxin. The analysis highlighted ularitide's role as a novel natriuretic peptide therapy while noting the need for more long-term studies comparing these medications to standard treatments.
Pollesello P, Ben Gal T, Bettex D · 2019
Review of short-acting therapies for acute and advanced heart failure that includes ularitide among vasodilator options. The article discusses ularitide's mechanism of action and clinical applications for rapidly improving heart failure symptoms in hospitalized patients.
Dai H, Li H, Wang B · 2022
Network meta-analysis comparing 15 different acute heart failure drugs across 23 clinical trials with 17,097 patients showed all drugs had similar effectiveness and safety profiles. Ularitide was included in this comprehensive comparison, demonstrating comparable outcomes to other natriuretic peptides and vasodilators.
Packer M, O'Connor C, McMurray JJV, et al. · 2017
Mitrovic V, Seferovic PM, Simeunovic D, Ristic AD, Miric M, Moiseyev VS, Kobalava Z, Nitsche K, Forssmann WG, Lüss H, Meyer M · 2006
Phase II trial in 221 patients with decompensated heart failure given 24-hour infusions of ularitide at 7.5, 15 or 30 ng/kg/min or placebo. Ularitide lowered pulmonary capillary wedge pressure and improved dyspnoea at 6 hours, reduced systemic vascular resistance and raised cardiac index at 15 and 30 ng/kg/min from 1 hour onward. Systolic blood pressure fell dose-dependently; the most frequently reported drug-related adverse events were hypotension (5.4%) and decreased blood pressure (5.4%), infusion was temporarily interrupted for systolic pressure at or below 80 mmHg in 13 of 168 ularitide patients, and serum creatinine was unchanged through day 3.
Lüss H, Mitrovic V, Seferovic PM, Simeunovic D, Ristić AD, Moiseyev VS, Forssmann WG, Hamdy AM, Meyer M · 2008
Renal analysis of the SIRIUS II trial: estimated glomerular filtration rate, serum creatinine, creatinine clearance and blood urea nitrogen were not impaired by ularitide throughout the 24-hour infusion or the 2-day follow-up. Ularitide at 15 ng/kg/min reduced blood urea nitrogen at 24 hours and preserved the mean arterial pressure minus right atrial pressure gradient while raising cardiac output.
Lee CYW, Burnett JC · 2007
Review of the natriuretic peptide family, including urodilatin. Binding to natriuretic peptide receptor A generates an increase in cyclic guanosine monophosphate, which mediates natriuresis, inhibition of renin and aldosterone, and vasorelaxant, anti-fibrotic, anti-hypertrophic and lusitropic effects.
Packer M, Holcomb R, Abraham WT, Anker S, Dickstein K, Filippatos G, Krum H, Maggioni AP, McMurray JJV, Mebazaa A, O'Connor C, Peacock F, Ponikowski P, Ruschitzka F, van Veldhuisen DJ, Holzmeister J · 2016
Design paper for the phase 3 TRUE-AHF trial: a 48-hour intravenous infusion of ularitide at 15 ng/kg/min begun within 12 hours of initial clinical presentation, with entry blood pressure criteria and predefined thresholds for adjusting the drug infusion rate, which aim to minimize the risk of hypotension.
Cardiorentis Ltd (PR Newswire) · 2015
On 11 December 2015 the FDA granted Fast Track designation to ularitide for acute decompensated heart failure. The release describes ularitide as the chemically synthesized form of urodilatin, given as an intravenous infusion, then in phase 3 development in the TRUE-AHF trial of 2,157 patients across more than 200 centres in the US, Europe, Canada and Latin America.
Head to head
Ularitide compared
Want the full picture?
The complete Ularitide research profile: mechanism of action, clinical studies, effectiveness timeline, and FAQ.