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); IV solution (lyophilized) |
| Stable identifiers | UNII: M6739UWY9H; PubChem CID: 16129708; CAS: 118812-69-4; DrugBank: DB04895 |
| Identity caveats | Japan-limited approval. Identical in sequence to endogenous 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 |
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 open-label registry, N=1,177); LASCAR-AHF RCT (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 |
Key studies
| Study | Design/population | Exposure studied | Endpoints and result | Limitations |
|---|---|---|---|---|
| COMPASS | Japanese prospective open-label registry, ADHF (N=1,177) | Carperitide vs standard care | Hemodynamic improvement, no mortality benefit | Registry design, not randomized; Japanese population only |
| Japanese Phase 3 | RCT, N=100+, ADHF | Carperitide IV 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 IV 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
WADA: 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 placebo-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.