Bottom line
Carperitide is recombinant human atrial natriuretic peptide (hANP) approved only in Japan since 1995 for acute heart failure. It is not approved by FDA, EMA, or MHRA. The COMPASS study provided the largest evidence base. Availability is Japan-limited.
Identity and composition
| Field | Verified information |
|---|---|
| Preferred name | Carperitide |
| Key aliases | HANP, alpha-hANP, Suntory brand, SUN-4936 |
| Molecular/sequence identity | Ser-Leu-Arg-Arg-Ser-Ser-Cys-Phe-Gly-Gly-Arg-Met-Asp-Arg-Ile-Gly-Ala-Gln-Ser-Gly-Leu-Gly-Cys-Asn-Ser-Phe-Arg-Tyr (28 aa); disulfide bridge Cys7–Cys23 |
| Modifications/form | Recombinant (yeast); Administered into a vein. Definition source: Neutral gloss; usage context: Routes, devices, and absorption primer · Glossary solution (Freeze-drying: water is removed by sublimation under reduced pressure, which can improve the stability of peptides and yield a porous dry matrix. Water removal does not sterilize a product, prove its quality, or define how it should later be handled. Definition source: Lyophilization, formulation, and stability primer · Glossary) |
| Stable identifiers | UNII: M6739UWY9H; The record number of a compound in PubChem, the atlas's primary structure-asset source. A registry record or depiction does not authenticate a commercial sample. Definition source: Identity and structure assets methodology · Glossary: 16129708; CAS: 118812-69-4; DrugBank: DB04895 |
| Identity caveats | Japan-limited approval. Identical in sequence to An entry with substantial scientific visibility or identity value. Biological rationale and non-human evidence do not establish patient benefit. Definition source: Scope and selection methodology · Glossary human ANP(1-28). Not interchangeable with nesiritide (BNP). |
Development and approval status
| Jurisdiction | Status and indication | Product/source | As of |
|---|---|---|---|
| Japan (PMDA) | Approved: acute heart failure (since 1995) | Carperitide (Daiichi Sankyo / Suntory) | 1995 |
| US (FDA) | Not approved | — | 2026 |
| EU/EEA (EMA) | Not approved | — | 2026 |
| UK (MHRA) | Not approved | — | 2026 |
- UNITED STATES
- US (FDA): Not approved
- EU/EEA
- EU/EEA (EMA): Not approved
- UNITED KINGDOM
- UK (MHRA): Not approved
- OTHER DOCUMENTED
- Japan (PMDA): Approved: acute heart failure (since 1995)
Sport status: WADA: Not prohibited.
Mechanism and pharmacology
Natriuretic peptide receptor-A (NPR-A) agonist. Binding to NPR-A on vascular smooth muscle, kidney, and endothelium increases cGMP, promoting vasodilation, natriuresis, and RAAS suppression. Reduces preload and afterload in acute heart failure. ANP has slightly different receptor affinity profile from BNP (nesiritide).
Evidence by claim
| Claim/indication | Stage | Grade | Best human evidence | Main result | Important limitations |
|---|---|---|---|---|---|
| Acute heart failure (hemodynamic and symptom improvement) | Approved (Japan only) | B | COMPASS (prospective A study in which participants and investigators know what is administered. Definition source: Neutral gloss; usage context: Evidence grading methodology · Glossary registry, N=1,177); LASCAR-AHF A study in which participants are assigned to the study material or a comparator by chance. Definition source: Neutral gloss; usage context: Evidence grading methodology · Glossary (N=247, PMID 39656827) | COMPASS: hemodynamic improvement; LASCAR-AHF: no reduction in mortality/HF hospitalization or dyspnea improvement | COMPASS is a registry, not a randomized comparative trial; LASCAR-AHF found no benefit on primary endpoints |
- AGrade A: Established for a specific labeled use
- BGrade B: Moderate human evidence
- CGrade C: Preliminary human evidence
- DGrade D: Preclinical only
- EGrade E: Anecdotal/marketing claim
- XGrade X: Evidence contradicts or does not support the claim
Text alternative for the claim-evidence diagram. Each grade is defined below:
- A — Established for a specific labeled use
- 0 claims
- B — Moderate human evidence
- 1 claim: Acute heart failure (hemodynamic and symptom improvement)
- C — Preliminary human evidence
- 0 claims
- D — Preclinical only
- 0 claims
- E — Anecdotal/marketing claim
- 0 claims
- X — Evidence contradicts or does not support the claim
- 0 claims
Key studies
| Study | Design/population | Exposure studied | Endpoints and result | Limitations |
|---|---|---|---|---|
| COMPASS | Japanese prospective A study in which participants and investigators know what is administered. Definition source: Neutral gloss; usage context: Evidence grading methodology · Glossary registry, ADHF (N=1,177) | Carperitide vs standard care | Hemodynamic improvement, no mortality benefit | Registry design, not randomized; Japanese population only |
| Japanese Phase 3 | A study in which participants are assigned to the study material or a comparator by chance. Definition source: Neutral gloss; usage context: Evidence grading methodology · Glossary, N=100+, ADHF | Carperitide Administered into a vein. Definition source: Neutral gloss; usage context: Routes, devices, and absorption primer · Glossary 0.0125–0.05 mcg/kg/min | Improved cardiac index, PCWP, dyspnea | Small sample; dated |
Dose and administration evidence
Approved labeled regimen
The label summary below is product-, indication-, and jurisdiction-specific; consult the full current label and a licensed clinician/pharmacist.
Acute heart failure (Japan label): 0.0125–0.05 mcg/kg/min Administered into a vein. Definition source: Neutral gloss; usage context: Routes, devices, and absorption primer · Glossary continuous infusion. No bolus dose. Higher rates may increase hypotension risk.
Studied regimens (not recommendations)
COMPASS: 0.0125–0.05 mcg/kg/min IV.
Other studies: 0.1 mcg/kg/min (associated with more hypotension).
What is not established
Mortality benefit not demonstrated.
Use outside Japan in controlled settings.
No established or recommended human dose for unapproved indications.
Safety
Established label risks
Hypotension: Dose-related; may require dose reduction or discontinuation.
Renal: Transient creatinine increase.
GI: Nausea.
Electrolyte: Hyperkalemia.
Human-study signals
No adequately powered mortality study completed.
Unknowns and product-quality risks
A Japanese authorization was identified; no FDA-approved product or EMA-authorized medicine was identified, and availability elsewhere requires a current national-register check.
No Good Manufacturing Practice assurance for non-Japanese sources.
Research-grade vials from non-Japanese sources are not audited by PMDA.
Interactions and special populations
Additive hypotension with other vasodilators.
ACE inhibitors may potentiate effect.
Renal impairment: adjust infusion rate.
Regulatory, compounding, and sport notes
The World Anti-Doping Agency; its Prohibited List classifies many peptides as prohibited substances in sport. Definition source: WADA and sport regulation brief · Glossary: Not prohibited.
Not scheduled under US CSA.
The reviewed authorization is Japanese. This page makes no categorical claim about authorization or availability in every other jurisdiction.
Evidence gaps
No mortality benefit demonstrated.
No contemporary An inactive comparator used in a controlled study. Definition source: Neutral gloss; usage context: Evidence grading methodology · Glossary-controlled trial outside Japan.
No comparison to standard of care (nesiritide, nitroglycerin) in Western populations.
Search notes
Databases and registries: PMDA (Japanese), PubMed, ClinicalTrials.gov
Search terms: carperitide, HANP, atrial natriuretic peptide, acute heart failure, Japan
Last searched: 2026-08-06
Inclusion emphasis: Japanese label, phase 3 trials, regulatory status
Sources
PMDA. Carperitide (HANP) prescribing information. https://www.pmda.go.jp/
PubChem. Carperitide. https://pubchem.ncbi.nlm.nih.gov/compound/16129708
DrugBank. Carperitide. https://go.drugbank.com/drugs/DB04895
Suwa M, et al. Carperitide for acute heart failure in Japan. Circ J. 2007;71(12):1880–5. PMID: 18037740.
