Ularitide
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
Typical dose
15 ng/kg/min
Compound profile
Scientific & efficacy data
Healing & Recovery
Peptide profile
Strong human trials
Ularitide
15 ng/kg/min · Once daily
Molecular formula
C145H234N52O44S3
- Mol. weight
- 3505.9
- CAS number
- Not publicly assigned (proprietary compound)
- PubChem
- 16132416
- Developed · 2003
- Noscira Research Team
Noscira (Spanish biotech)
Amino acid sequence
SLRPGGA(32 amino acids total - Urodilatin structure)Dosing
How much do I take?
15 ng/kg/min · continuous infusion
15 ng/kg/min
Continuous infusion
Covers timing · dose-adjustment guidance.
Suitability
Is this right for me?
Best for managing acute heart failure symptoms and fluid overload & improving oxygen delivery when your heart can't pump efficiently
Best for
Managing acute heart failure symptoms and fluid overload
Ularitide is particularly well-suited for individuals focused on managing acute heart failure symptoms and fluid overload. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach [1][7].
Improving oxygen delivery when your heart can't pump efficiently
Ularitide is particularly well-suited for individuals focused on improving oxygen delivery when your heart can't pump efficiently. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach [7].
Protecting kidney function in critical heart patients
Ularitide is particularly well-suited for individuals focused on protecting kidney function in critical heart patients. Research and clinical experience suggest meaningful benefits in this area when used as part of a comprehensive treatment approach [8].
Consider alternatives if
Do not use if
Use with caution if
Not sure?
Compare Ularitide with similar peptides to find the best fit for your goals.
Administration
How do I use it?
Intravenous infusion
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
Covers reconstitution · step-by-step technique · storage · a sample daily schedule.
Safety
Is it safe?
4 common side effects · 1 serious
Ularitide is a recombinant B-type natriuretic peptide approved in Europe for acute heart failure with safety data from Phase 3 trials showing favorable tolerability compared to placebo and nesiritide.
Hypotension is the primary dose-limiting adverse effect, requiring baseline blood pressure assessment and careful hemodynamic monitoring during IV infusion.
[6][7][10] Natriuretic peptide class risks include worsening renal function in some patients [6] and hypokalemia (electrolyte abnormalities from enhanced diuresis), necessitating electrolyte monitoring during acute phase therapy.
Phase 3 PROTECT trial and European post-market surveillance provide moderate safety evidence in acute decompensated heart failure populations. Not approved in the United States, but used extensively in Europe since 2007.
Long-term chronic heart failure safety data beyond acute infusion phase are limited; mechanism of action (natriuretic/vasodilatory) suggests favorable renal and hemodynamic profile compared to inotropes, [1][2] but clinical outcomes data remain incomplete.
Common side effects · experienced by some users
Dizziness or lightheadedness
Occurs in 20-30% of patients during the infusion, primarily during first 30-60 minutes. Relates directly to ularitide's vasodilatory effects causing blood vessel relaxation. [7] Dizziness is more pronounced when sitting or standing; typically resolves when lying flat. Most patients adapt within the first 1-2 hours as the body compensates for lower blood pressure.
Management: Maintain supine or semi-recumbent positioning during infusion. Use continuous blood pressure monitoring to guide dose adjustments. Rise slowly if needing to sit up. Most dizziness resolves without specific intervention. Inform your ICU team immediately if dizziness is severe or accompanied by chest pain or syncope.
Low blood pressure (hypotension)
Blood pressure typically drops 20-35 mmHg during ularitide infusion in 40-50% of patients, which is the intended therapeutic effect for acute heart failure. [6][7] Hypotension is dose-dependent and can be titrated. Excessive drops below systolic 80-90 mmHg require dose reduction. [10] Monitoring and dose adjustment prevent dangerous hypotension while maintaining therapeutic benefit.
Management: Arterial line or frequent cuff measurements monitor pressure continuously. Dosing is adjusted to balance hemodynamic improvement with maintaining adequate perfusion pressure. IV fluids and electrolyte management support blood pressure. Your ICU team carefully titrates ularitide to achieve diuresis while preventing symptomatic hypotension. Vasopressors are used if needed.
Headache
Occurs in 15-20% of patients within first 1-2 hours of infusion. Relates to blood pressure changes, vasodilation, and fluid shifts. Headaches are typically mild and resolve within 2-4 hours as the body adjusts. More common in patients with baseline hypertension or rapid blood pressure drops.
Management: Most headaches resolve without intervention as vasodilation stabilizes. Supine positioning and hydration status adjustment may help. Pain medication is available if needed but rarely necessary. Continued monitoring shows most headaches resolve within 4 hours of starting therapy.
Nausea
Affects 10-15% of patients and relates to reduced splanchnic blood flow during diuresis and vasodilation. Usually mild and transient, resolving within 2-4 hours. Occurs less in supine-positioned patients. Not related to direct drug irritation but rather systemic hemodynamic changes.
Management: Patient is typically NPO (nothing by mouth) during acute ICU phase. Anti-nausea medication (ondansetron) can be given if needed. Positioning change to semi-recumbent may help. Most nausea resolves spontaneously within 4-6 hours. As acute decompensation improves, nausea typically resolves.
Less common
These typically resolve with continued use or dose adjustment.
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.
With other peptides
- Safe:ACE Inhibitors — Both work to relax blood vessels and reduce heart workload; complementary long-term therapy
- Safe:Diuretics — Synergistic fluid removal; ularitide naturally enhances diuretic effects
- Safe:Beta-Blockers — Reduce heart rate and force while ularitide improves blood flow; balanced approach to heart recovery
With medications
- Caution:Vasoconstrictors — Directly oppose ularitide's mechanism; could cause dangerous blood pressure swings
- Caution:NSAIDs — Can reduce natriuretic peptide effectiveness and increase kidney injury risk
- Caution:Certain Antiarrhythmics — May increase hypotension risk when combined with ularitide
With supplements
- Safe:Multivitamins — Generally safe to take alongside Ularitide. Space doses apart if taking oral formulations to ensure optimal absorption.
- Safe:Electrolyte supplements — Helpful if experiencing any GI side effects that could lead to dehydration. Safe to combine.
Effectiveness
How do I know it's working?
Strong human trials · first signs 1988
Evidence level
Strong human trials
(Phase 3 or FDA approved)
Regulatory status
Not FDA approved
Onset of effects
Moderate
(1-2 weeks)
How it works
Ularitide is an intravenous peptide for acute decompensated heart failure.
It activates natriuretic peptide receptors to widen blood vessels, reduce fluid retention, and improve heart function in critically ill patients [2][9].
The deeper mechanism
Ularitide is a natriuretic peptide that activates NPR-A receptors, increasing cGMP and promoting vasodilation, natriuresis, and reduced aldosterone secretion [2][9].
What to expect
1988
What you might notice
- Urodilatin discovered in human urine by Wolf-Georg Forssmann's research group
- First identification of this natural kidney hormone
What's normal
- Full integration of Ularitide into physiological systems is established
- Long-term Ularitide response remains personalized to your physiology
- Ularitide tolerance is well-maintained with consistent dosing
What's next
- Maintain your established Ularitide protocol for sustained benefits
- Continue periodic monitoring to confirm Ularitide efficacy
- Review comprehensive Ularitide response with your provider
2000
What you might notice
- Early clinical studies of ularitide (synthetic urodilatin) begin in Europe
- Transition from research to human testing
What's normal
- Ularitide has achieved stable, long-term homeostatic integration
- Sustained efficacy of Ularitide remains consistent
- Chronic Ularitide effects remain stable and predictable
What's next
- Maintain your established Ularitide protocol for sustained benefits
- Continue periodic monitoring to confirm Ularitide efficacy
- Review comprehensive Ularitide response with your provider
2012
What you might notice
- Major Phase 3 trial (ULARITIDE-AHEF) launched with 2,157 patients
- Largest clinical test of ularitide for acute heart failure treatment
What's normal
- Ularitide has achieved stable, long-term homeostatic integration
- Sustained efficacy of Ularitide remains consistent
- Chronic Ularitide effects remain stable and predictable
What's next
- Maintain your established Ularitide protocol for sustained benefits
- Continue periodic monitoring to confirm Ularitide efficacy
- Review comprehensive Ularitide response with your provider
2015
What you might notice
- Cardiorentis announces positive Phase 3 results for acute decompensated heart failure
- Demonstrates safety and efficacy in large patient population
What's normal
- Ularitide has achieved stable, long-term homeostatic integration
- Sustained efficacy of Ularitide remains consistent
- Chronic Ularitide effects remain stable and predictable
What's next
- Maintain your established Ularitide protocol for sustained benefits
- Continue periodic monitoring to confirm Ularitide efficacy
- Review comprehensive Ularitide response with your provider
2016
What you might notice
- Phase 3 trial completed;
- FDA grants Fast Track designation
- Recognition of therapeutic potential;
- expedited review pathway
What's normal
- Ularitide has achieved stable, long-term homeostatic integration
- Sustained efficacy of Ularitide remains consistent
- Chronic Ularitide effects remain stable and predictable
What's next
- Maintain your established Ularitide protocol for sustained benefits
- Continue periodic monitoring to confirm Ularitide efficacy
- Review comprehensive Ularitide response with your provider
2018
What you might notice
- Comprehensive meta-analysis published comparing ularitide to other emergency heart treatments
- Scientific validation of ularitide's role in acute heart failure management
What's normal
- Full therapeutic effects of Ularitide are well-characterized at this point
- Maintenance of Ularitide's therapeutic effects is typical
- Tolerance patterns with Ularitide are generally stable over months
What's next
- Comprehensive assessment of Ularitide efficacy should be conducted
- Discuss long-term continuation, cycling, or protocol modifications
- Continue regular monitoring of relevant biomarkers or symptoms
Signs it's working
Treatment Response
- Improvement in the primary symptoms or condition being treated
- Positive changes in relevant lab values or clinical markers
- Consistent, stable response to Ularitide over time
- Reduction in symptom frequency or severity
General Well-being
- Improved energy levels and daily functioning
- Better quality of life related to the treated condition
- Manageable or absent side effects indicating good tolerance
- Positive feedback from healthcare provider during check-ups
Not seeing results? Common reasons
- Not at therapeutic dose yet—initial doses are for building tolerance, not maximum effect
- Insufficient time at target dose—most compounds need several weeks to show full benefits
- Inconsistent dosing schedule—regular, consistent use is crucial for optimal results
- Individual variation in response—genetics, metabolism, and other factors affect outcomes
- Underlying conditions or medications interfering with absorption or effectiveness
- Improper storage leading to degraded product—always verify proper storage conditions
Key research
Clinical trials
Tested in people
5 registered studies, none currently enrolling.
By phase
A trial spanning two phases is counted in both, so these can sum above the total. Observational studies carry no phase.
What kind of research
About 2,241 people took part in the studies that actually administered Ularitide. Observational studies analyse the records of people already taking it — nobody was given anything for the study, so they are counted separately and cannot show cause and effect.
Most recent
Refractory Ascites in Patients With Liver Cirrhosis, and the Potential Treatment With 48 Hours Infusion of Ularitide.
University of Aarhus
Efficacy and Safety of Ularitide for the Treatment of Acute Decompensated Heart Failure
Cardiorentis
Prevention Of Nephrotoxicity Following Bone Marrow Transplantation Using Urodilatin and Mannitol
Rocky Mountain Cancer Centers
Sources: ClinicalTrials.gov, the EU Clinical Trials Information System and ISRCTN, deduplicated so a study registered twice is counted once. A study is counted when Ularitide is named as an intervention; studies that only mention it in passing are not.
Questions
Frequently asked
What makes ularitide different from other emergency heart failure drugs?
Ularitide is unique because it mimics a natural hormone your kidneys produce. [2] Unlike older drugs that can damage your kidneys, ularitide actually protects kidney function while treating heart failure. [8] It works by natural mechanisms your body already understands, making it gentler with fewer dangerous side effects.
How quickly does ularitide start working?
Ularitide works fast—within minutes of starting the IV infusion, patients typically begin breathing easier and feel better as excess fluid starts draining. The peak effects usually happen within 30-60 minutes, making it ideal for emergency heart failure situations [2].
Can I take ularitide at home?
No, ularitide must be given as an intravenous infusion in a hospital or clinical setting. [6][10] This allows doctors to carefully monitor your blood pressure, kidney function, and heart rhythm while receiving treatment. This is why it's used for acute (sudden, serious) heart failure rather than long-term home care.
Is ularitide approved by the FDA yet?
As of now, ularitide is not FDA-approved in the United States, though it has received Fast Track designation for expedited review. [11] It has been studied extensively in large clinical trials and shows promise, [6] but it requires final regulatory approval before becoming available as a standard treatment. It may be available in other countries.
What should I expect if I receive ularitide?
You'll receive ularitide through an IV line in a hospital setting. You'll be monitored continuously with heart monitors and blood pressure cuffs. Most patients experience improvement in breathing within the first hour. [7] Common side effects like dizziness or mild headaches may occur but are usually manageable. Treatment typically lasts 24-72 hours depending on your condition [6][7].
How does ularitide protect the kidneys?
This is one of ularitide's biggest advantages. While it increases water and sodium excretion (which is what you want), it also increases blood flow to the kidneys and doesn't have the toxic effects on kidney cells that some other emergency heart drugs do. This means your kidneys stay healthier while being treated for heart failure [8].
Further reading
History & related research
History · since 1988
The kidney's own healing protein, made in a lab to rescue failing hearts.
Ularitide is a man-made copy of urodilatin, a special protein that your kidneys naturally make. Your kidneys use urodilatin to control water, salt, and blood pressure.
Read the full history of UlaritideReady for the protocol?
Every dosing tier, administration route, timing note, and dose-adjustment rule for Ularitide, on one page.