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Vasoactive Intestinal Peptide

Twenty-eight-residue neuropeptide

Also known as VIP, Aviptadil, RLF-100

A well characterized endogenous neuropeptide with an enormous basic literature, and a clinical history dominated by one contested and heavily publicized COVID-19 program.

What doses have been studied? What each trial gave, with the population it was given to.

Guide updated Oct 22, 2026Literature checked Oct 21, 20261 curated study48 literature recordsBaseline editorial
SequenceHSDAVFTDNYTRLRKQMAVKKYLNSILN

Overview

In shortA signaling peptide found throughout the gut, lungs and nervous system, where it widens blood vessels, opens airways and adjusts immune responses. The basic science on it is vast and long predates any interest in it as a treatment. Its recent public profile comes almost entirely from a synthetic version trialed for respiratory failure in COVID-19.

VIP is a 28-amino-acid neuropeptide found throughout the gut, lungs and nervous system, where it acts as a vasodilator, a bronchodilator and an immune modulator. The basic science on it is vast, over fourteen thousand papers, and long predates any interest in it as a therapy.

Its recent public profile comes almost entirely from aviptadil, a synthetic form trialed for respiratory failure in COVID-19. That program was accompanied by unusually assertive public claims, and the regulatory outcome did not match them. Anyone reading about VIP now is mostly reading the residue of that episode.

Mechanism

In shortIt acts on two receptors, raising a common internal signaling molecule. In the lung it concentrates in the cells that make surfactant, which is the reasoning behind the lung injury work: protect those cells and you may preserve surfactant production. Around the body it strongly widens blood vessels, which is both how it works and the thing that limits the dose.

Acts at VPAC1 and VPAC2 receptors, raising intracellular cAMP. In the lung it is concentrated in alveolar type II cells, which is the rationale for the acute lung injury work: protecting those cells is a plausible route to preserving surfactant production.

Systemically it is a potent vasodilator, which is both the mechanism and the dose-limiting problem.

Evidence

In shortA huge amount of basic science, and modest registered clinical work by comparison, mostly in lung conditions. The COVID-19 program is the case study in reading past a press release: public claims about survival were not matched by any regulatory finding, and emergency authorization was not granted. The trials are in the registry and that is the appropriate source.

Extensive mechanistic and physiological literature. Registered clinical work is modest by comparison and centers on pulmonary indications, including pulmonary arterial hypertension, sarcoidosis and acute respiratory distress.

The COVID-19 program is the case study in reading past a press release. Claims made publicly about survival benefit were not matched by a regulatory finding, and emergency use authorization was not granted. The trials are in the registry and are the appropriate source; contemporaneous reporting about them mostly is not.

Safety

In shortLow blood pressure and flushing follow directly from its blood-vessel-widening action and are what limits the dose. Diarrhea is common, which fits its normal job in the gut. It disappears from the bloodstream very quickly, so how it is formulated and delivered dominates the practical safety picture as much as the molecule does.

Hypotension and flushing follow directly from the vasodilatory mechanism and are the dose-limiting effects. Diarrhea is common, consistent with its physiological role in the gut.

Its half-life in circulation is very short, which is why formulation and route dominate the practical safety picture as much as the molecule does.

Regulatory status

In shortThe synthetic form holds rare-disease designation in some countries but is not approved for general use, and emergency authorization for COVID-19 was not granted in the US. Material sold under this name outside those programs is research-use-only, and the sequence is easy to state and hard to manufacture consistently.

Aviptadil holds orphan designation in some jurisdictions but is not approved for general use, and emergency authorization for COVID-19 respiratory failure was not granted in the United States.

Material sold as VIP outside those programs is research-use-only. The 28-residue sequence is easy to state and difficult to manufacture to a consistent standard.

The literature

1 study indexed. Findings and limitations get equal weight, on purpose.

Always check the primary source

Members area

The Vasoactive Intestinal Peptide literature needs an account

Everything above is free to read. What an account opens is the evidence underneath it: 1 study with their limitations, and the regimen each trial actually reported.

  • Every study, with what it found and what it cannot show
  • The limitations, given the same weight as the findings
  • The dose each named trial administered, where recorded

Free to create. A membership is separate, and you can decide about that later.

Reading is free, an account is not the same as paying. 80 compound guides, every study with its limitations written underneath, and the regimens those trials actually used. A free account opens all of it. A membership is a separate decision, and it opens the forum. What membership costs.

The wider literature

25 indexed papers and 23 registered trials mentioning Vasoactive Intestinal Peptide, straight from PubMed and ClinicalTrials.gov. 18 of 23 administer it; the rest measure it. These have not been read by us. Unlike the studies above, they carry no findings and no limitations written by anyone here, because writing either would mean claiming a reading nobody has done. They are a starting point for yours.

Registered trials (23)

  1. ZYESAMI (Aviptadil) Intermediate Population Expanded Access Protocol (SAMICARE)

    APR Applied Pharma Research s.a.NCT04453839

    expanded_accessno longer available

  2. The Volunteering-in-Place Program for Apathetic Assisted Living Residents With ADRD

    University of Maryland, Baltimore2026NCT06735950

    interventionalnanot yet recruitingn=200

  3. Neuropeptide Expression During the Ovarian Cycle and in Patients With PCOS

    University Of Perugia2023NCT05958914

    interventionalnaunknownn=45

  4. Inhaled ZYESAMI (Aviptadil Acetate) for Treatment of Severe COVID-19

    APR Applied Pharma Research s.a.2021NCT05137795

    interventionalphase3withdrawnn=0

  5. Inhaled ZYESAMI™ (Aviptadil Acetate) for the Treatment of Severe COVID-19

    APR Applied Pharma Research s.a.2021NCT04360096

    interventionalphase2phase3terminatedn=144

  6. Aviptadil for Severely Ill Inpatients With COVID-19 (An ACTIV-3b/TESICO Treatment Trial)

    National Institute of Allergy and Infectious Diseases (NIAID)2021NCT06729606

    interventionalphase3completedn=471

  7. ACTIV-3b: Therapeutics for Severely Ill Inpatients With COVID-19

    National Institute of Allergy and Infectious Diseases (NIAID)2021NCT04843761

    interventionalphase3completedn=473

  8. A Clinical Study Evaluating Inhaled Aviptadil on COVID-19

    Centurion Pharma2021NCT04844580

    interventionalphase2completedn=80

  9. The Effects of a Long-lasting Infusion of Vasoactive Intestinal Peptide (VIP) in Episodic Migraine Patients

    Danish Headache Center2020NCT04260035

    interventionalnacompletedn=21

  10. Pemziviptadil (PB1046), a Long-acting, Sustained Release Human VIP Analogue, Intended to Provide Clinical Improvement to Hospitalized COVID-19 Patients at High Risk for Rapid Clinical Deterioration and Acute Respiratory Distress Syndrome (ARDS).

    PhaseBio Pharmaceuticals Inc.2020NCT04433546

    interventionalphase2terminatedn=54

  11. The Effects of a Long-lasting Infusion of Vasoactive Intestinal Peptide (VIP) on Headache, Cranial Hemodynamic and Autonomic Symptoms in Healthy Volunteers

    Danish Headache Center2019NCT03989817

    interventionalnacompletedn=12

  12. Phase 2 Study to Assess Safety, Tolerability and Efficacy of Once Weekly SC Pemziviptadil (PB1046) in Subjects With Symptomatic PAH

    PhaseBio Pharmaceuticals Inc.2018NCT03556020

    interventionalphase2terminatedn=35

  13. A Study to Assess the Safety, Tolerability, and Hemodynamic Response of PB1046 in Subjects With PAH

    PhaseBio Pharmaceuticals Inc.2017NCT03315507

    interventionalphase1completedn=3

  14. Vaccination In Pregnancy Gene Signature: VIP Signature Study

    St George's, University of London2017NCT03284515

    observationalcompletedn=30

  15. Plastic Bronchitis and Protein Losing Enteropathy in Children With Single Ventricle Physiology

    Medical College of Wisconsin2012NCT01563757

    observationalcompletedn=20

  16. Effect of PACAP38/VIP on Migraineurs Measured by Magnetic Resonance

    Glostrup University Hospital, Copenhagen2011NCT01471990

    interventionalnacompletedn=24

  17. Reduction of Right Ventricular Pacing Using the Feature Ventricular Intrinsic Preference (VIP)

    Abbott Medical Devices2006NCT00311168

    interventionalnacompletedn=135

  18. Clinical Study of Chemoradiation Followed by VIPD in Nasal Natural Killer (NK)/T-cell Lymphoma

    Samsung Medical Center2006NCT00418535

    interventionalphase2completed

  19. Hemodynamic and Headache-Inducing Effect of Intravenous Vasoactive Intestinal Peptide in Migraineurs

    Danish Headache Center2004NCT00272896

    interventionalnacompletedn=12

  20. Evaluation of Histamine, CGRP and VIP as Markers for Activation of Trigeminal and Parasympathetic Nerve Fibers

    Clinvest2004NCT00208065

    interventionalphase4completedn=50

  21. Experimental Headache Induced by Vasoactive Intestinal Polypeptide

    Danish Headache Center2003NCT00255320

    interventionalnacompletedn=12

  22. Vasoactive Intestinal Peptide in COPD

    Medical University of Vienna2003NCT00464932

    observationalcompletedn=34

  23. Phase I Study of Vasoactive Intestinal Peptide in Patients With Acute Respiratory Distress Syndrome and Sepsis

    Stony Brook University1998NCT00004494

    interventionalphase1completedn=18

Papers (25)

  1. Aviptadil in Acute Respiratory Distress Syndrome-Promise or Mirage?

    Chanchalani GIndian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine2025PMID 41368453

    editorial

  2. Anticipated pharmacological role of Aviptadil on COVID-19.

    Mukherjee T, et al.Environmental science and pollution research international2022PMID 34846667

    journal articlereview

  3. The Use of IV Vasoactive Intestinal Peptide (Aviptadil) in Patients With Critical COVID-19 Respiratory Failure: Results of a 60-Day Randomized Controlled Trial.

    Youssef JG, et al.Critical care medicine2022PMID 36044317

    journal articlemulticenter studyrandomized controlled trialresearch support, non-u.s. gov't

  4. Editorial: GPCR in Inflammatory and Cancer Diseases.

    Couvineau A, et al.Frontiers in endocrinology2020PMID 33101216

    editorialintroductory journal article

  5. Vasoactive Intestinal Peptide in Checkpoint Inhibitor-Induced Pneumonitis.

    Frye BC, et al.The New England journal of medicine2020PMID 32579820

    case reportsletter

  6. Erectile dysfunction: a global review of intracavernosal injectables.

    Duncan C, et al.World journal of urology2019PMID 30895359

    journal articlesystematic review

  7. The effects of vasoactive intestinal peptide in neurodegenerative disorders.

    Deng G, et al.Neurological research2017PMID 27786097

    journal articlereview

  8. Vasoactive Intestinal Peptide (VIP) Nanoparticles for Diagnostics and for Controlled and Targeted Drug Delivery.

    Klippstein R, et al.Advances in protein chemistry and structural biology2015PMID 25819279

    journal articleresearch support, non-u.s. gov'treview

  9. Analytics of the therapeutic peptide aviptadil by sheathless CE-MS and comparison with nanoRP-HPLC-MS.

    Gross PC, et al.Journal of pharmaceutical and biomedical analysis2014PMID 24176753

    comparative studyjournal articleresearch support, non-u.s. gov't

  10. Parasympathetic vasoactive intestinal peptide (VIP): a likely contributor to clozapine-induced sialorrhoea.

    Ekström J, et al.Oral diseases2014PMID 23731177

    journal articleresearch support, non-u.s. gov't

  11. Editorial: vasoactive intestinal peptide (vip): historic perspective and future potential.

    Foster NEndocrine, metabolic & immune disorders drug targets2012PMID 23094826

    editorialresearch support, non-u.s. gov't

  12. VIP-induced neuroprotection of the developing brain.

    Passemard S, et al.Current pharmaceutical design2011PMID 21524251

    journal articlereview

  13. Pulmonary arterial hypertension: on the way to a manageable disease.

    Mucke HACurrent opinion in investigational drugs (London, England : 2000)2008PMID 18729002

    journal articlereview

  14. Inhalation of vasoactive intestinal peptide in pulmonary hypertension.

    Leuchte HH, et al.The European respiratory journal2008PMID 18978135

    journal article

  15. Development of simplified vasoactive intestinal peptide analogs with receptor selectivity and stability for human vasoactive intestinal peptide/pituitary adenylate cyclase-activating polypeptide receptors.

    Igarashi H, et al.The Journal of pharmacology and experimental therapeutics2005PMID 15994369

    journal article

  16. Aviptadil (Senatek).

    Keijzers GBCurrent opinion in investigational drugs (London, England : 2000)2001PMID 11566015

    journal articlereview

  17. Immunobiology of vasoactive intestinal peptide (VIP).

    Pozo D, et al.Immunology today2000PMID 10637552

    journal articlereview

  18. A new vasoactive intestinal peptide antagonist discriminates VIP receptors on guinea pig trachea and human neuroblastoma cells.

    Leroux F, et al.Regulatory peptides1994PMID 7972935

    comparative studyjournal article

  19. Characterization of functional receptors for vasoactive intestinal peptide (VIP) in rat peritoneal macrophages.

    Segura JJ, et al.Regulatory peptides1991PMID 1652777

    journal articleresearch support, non-u.s. gov't

  20. Effects of intracoronary infusion of the vasoactive intestinal peptide antagonist [4Cl-D-Phe6-Leu17]VIP in the awake dog.

    Quebbemann BB, et al.Peptides1991PMID 1800959

    journal articleresearch support, non-u.s. gov'tresearch support, u.s. gov't, p.h.s.

  21. Vasoactive intestinal peptide (VIP)-like immunoreactivity in the human sympathetic ganglia.

    Järvi R, et al.Histochemistry1989PMID 2565893

    journal article

  22. Vasoactive intestinal peptide (VIP), a putative neurotransmitter of nonadrenergic, noncholinergic (NANC) inhibitory innervation and its relevance to therapy.

    Venugopalan CSJournal of veterinary pharmacology and therapeutics1989PMID 2568497

    journal articlereview

  23. Interaction of thymic peptide thymosin alpha 1 with vasoactive intestinal peptide (VIP) receptors.

    Calvo JR, et al.Bioscience reports1986PMID 3028522

    journal article

  24. Interaction of vasoactive intestinal peptide (VIP) with rat lymphoid cells.

    Calvo JR, et al.Peptides1986PMID 3016677

    journal article

  25. A new neuroregulator: the vasoactive intestinal peptide or VIP.

    Rosselin G, et al.Molecular and cellular endocrinology1982PMID 6290287

    journal articlereview

Discussion

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For Research & Educational Discussion Only. Not Medical Advice

This guide is educational reference material compiled from published literature. It is not medical advice, not a recommendation, and not a substitute for a clinician who knows your history. Nothing here should be used to make a decision about your own health without one.

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