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approvedCardiovascular

Carperitide

Also known as: hANP, HANP, Recombinant Human ANP, α-Human Atrial Natriuretic Peptide, Hanarup

Carperitide is the recombinant form of human atrial natriuretic peptide (α-hANP), a 28-amino acid cardiac hormone. It is approved in Japan for the treatment of acute decompensated heart failure, where it has been widely used since 1995. Carperitide promotes natriuresis, diuresis, and vasodilation through activation of the NPR-A/cGMP pathway, reducing cardiac preload and afterload. Despite decades of clinical use in Japan, its mortality benefit remains debated, and it has not gained regulatory approval outside of Japan.

3 cited references·6 researched benefits

Quick Answer

Carperitide (Hanarup) is recombinant human atrial natriuretic peptide approved in Japan since 1995 for acute decompensated heart failure. It is administered as a continuous IV infusion at 0.025-0.05 mcg/kg/min, producing natriuresis, vasodilation, and RAAS suppression that reduce cardiac preload and afterload. Despite widespread use in Japanese clinical practice, carperitide has a very short half-life (~2-3 minutes) and its long-term mortality benefit has not been definitively established in randomized controlled trials.

Key Facts

Mechanism
Carperitide is identical in structure and function to endogenous human ANP. It binds to natriuretic peptide receptor A (NPR-A), activating the receptor's intrinsic guanylate cyclase domain and elevating intracellular cyclic GMP (cGMP). Downstream effects include: relaxation of vascular smooth muscle (vasodilation reducing preload and afterload); increased glomerular filtration rate and direct inhibition of sodium reabsorption in the collecting duct (natriuresis/diuresis); suppression of renin secretion and aldosterone synthesis (RAAS inhibition); and reduction of sympathetic nervous system activity. Carperitide is rapidly degraded by neutral endopeptidase (neprilysin) and cleared via NPR-C receptor internalization, resulting in its extremely short half-life of ~2-3 minutes.
Research Status
approved
Half-Life
~2-3 minutes
Molecular Formula
C₁₂₇H₂₀₃N₃₅O₄₀S₃
Primary Use
Cardiovascular
Table of Contents

Benefits

  • Rapidly reduces pulmonary capillary wedge pressure and cardiac preloadstrong
  • Promotes natriuresis and diuresis to relieve congestion in acute heart failurestrong
  • Vasodilation — reduces systemic vascular resistance and blood pressurestrong
  • Suppresses RAAS and sympathetic nervous system activationstrong
  • Renal protective effects — may preserve glomerular filtration during acute heart failuremoderate
  • Improves dyspnea and clinical symptoms in acute decompensationmoderate

Dosage Protocols

RouteDosage RangeFrequencyNotes
Intravenous infusion0.025–0.05 mcg/kg/min (Japanese standard)Continuous infusion, typically 24-72 hoursStandard dose in Japan is 0.025 mcg/kg/min, increased to 0.05 mcg/kg/min if response is insufficient. Some centers use doses up to 0.1 mcg/kg/min. Blood pressure monitoring essential; discontinue or reduce dose for systolic BP <90 mmHg.
Low-dose IV infusion (renal protection)0.01–0.02 mcg/kg/minContinuous infusion for 12-48 hours post-cardiac surgeryInvestigated for prevention of acute kidney injury after cardiac surgery. Lower doses minimize hypotension risk while preserving renal blood flow.

Medical disclaimer

Dosage information is provided for educational reference only. Always follow your prescriber's instructions and consult a qualified healthcare provider before starting any peptide protocol.

Side Effects

  • Hypotension (most significant and dose-limiting)common
  • Excessive diuresis leading to volume depletioncommon
  • Headachecommon
  • Worsening renal function at higher infusion ratesrare
  • Severe symptomatic hypotension requiring vasopressor supportserious
  • Electrolyte disturbances (hyponatremia, hypokalemia)rare

Frequently Asked Questions

Why is carperitide approved only in Japan?
Carperitide was developed and approved in Japan in 1995 based on clinical trials demonstrating hemodynamic improvements in acute heart failure. However, these trials predated modern standards requiring mortality endpoints and were relatively small. Subsequent observational studies raised concerns about potential mortality harm at higher doses, and no large randomized controlled trial (like the TRUE-AHF trial for ularitide) was conducted to definitively establish or refute mortality benefit. Western regulatory agencies (FDA, EMA) have not reviewed carperitide for approval, partly because the natriuretic peptide approach was overtaken by sacubitril/valsartan (Entresto) for chronic heart failure.
How does carperitide compare to nesiritide?
Both are recombinant natriuretic peptides used for acute heart failure. Carperitide is recombinant ANP (28 amino acids, ~2-3 min half-life), while nesiritide is recombinant BNP (32 amino acids, ~18-20 min half-life). Nesiritide was approved in the US but fell out of favor after the ASCEND-HF trial showed no mortality benefit and concerns about renal worsening. Carperitide remains in clinical use in Japan, where it is preferred over nesiritide. Both have been largely supplanted conceptually by sacubitril/valsartan, which raises endogenous natriuretic peptide levels indirectly.
Can carperitide protect the kidneys during heart failure?
Low-dose carperitide infusion (0.01-0.02 mcg/kg/min) has been investigated for renal protection, particularly in post-cardiac surgery patients at risk of acute kidney injury. By dilating renal afferent arterioles and promoting natriuresis, it may help maintain renal blood flow during hemodynamic stress. Some Japanese observational studies and small RCTs have reported reduced AKI incidence, but results are inconsistent, and no large definitive trial has confirmed this benefit. The extremely short half-life requires continuous infusion, limiting practical application.

References

  1. 1
    Carperitide (alpha-human atrial natriuretic peptide) for acute heart failure in Japan: clinical experience and review(2000)PubMed ↗
  2. 2
    Effect of carperitide on mortality and morbidity in acute decompensated heart failure: a retrospective cohort analysis(2012)PubMed ↗
  3. 3
    Low-dose carperitide for renal protection in cardiac surgery: a systematic review(2008)PubMed ↗

Latest Research

Last updated: 2026-02-19