Aviptadil (synthetic VIP) is investigational and unapproved. Its studied regimens are hospital-administered under continuous monitoring, and there is no established self-administered dose for any indication. This page is educational context about how the compound has been delivered in research, not a protocol.
Overview
VIP dosing has an unusual property that answers most questions before they are asked: the studied dose is not measured in milligrams, and it is not self-administered. In the largest trial, aviptadil was given as continuous intravenous infusion over 12 hours a day, for three days, in patients who were in intensive care. The quantities are stated in picomoles per kilogram — units that only make sense with a pump, a scale, and a monitor.
That structure is not bureaucratic caution. It follows from the peptide's pharmacology: VIP is degraded rapidly in the body and drops blood pressure, so producing sustained exposure means infusing it continuously while watching what it does to the circulation.
The one documented regimen
TESICO, run at 28 US sites as part of the NIH ACTIV-3b programme, administered aviptadil as a daily 12-hour infusion for 3 days, targeting 600 pmol/kg on day 1, 1,200 pmol/kg on day 2, and 1,800 pmol/kg on day 3, with matched saline placebo in identical volumes for the control arm. Of the 461 patients in the modified intention-to-treat analysis, 94% were in an intensive care unit at baseline (Brown et al., Lancet Respir Med 2023; NCT04843761).
Two features of that regimen are worth noting. It is an escalating three-day course with a defined end, not an ongoing therapy — and it did not work: the primary ordinal outcome at day 90 gave an odds ratio of 1.11 (p=0.54), mortality was 38% versus 36% on placebo, and the data and safety monitoring board stopped the aviptadil arm for futility. A carefully designed dosing schedule and a negative result are compatible, and treating the schedule as validated because it was published would be a misreading.
Why the dose is expressed in pmol/kg
Picomolar units signal that VIP is active at concentrations far below the milligram range familiar from research peptides. It is a signalling molecule the body already produces and tightly regulates, and the therapeutic question is about restoring or amplifying a physiological concentration rather than delivering a bulk quantity of drug.
This is why milligram figures quoted for "VIP" in consumer contexts are difficult to interpret at all: they are not commensurable with any published regimen, and no conversion exists between a weight-based infusion target and a fixed amount sprayed into a nostril. Anyone reading a milligram or microgram number for VIP is reading a figure with no trial behind it.
Route changes the question entirely
Because VIP is cleared rapidly by enzymatic degradation, route determines exposure more than quantity does.
- Intravenous infusion maintains a controlled plasma concentration against fast clearance — which is why it requires a hospital, and why the same total quantity given as a bolus would be a different, and hemodynamically riskier, event.
- Inhaled delivery targets lung tissue directly rather than the systemic circulation. A separate multicenter randomised trial in 80 hospitalised COVID-19 pneumonia patients used inhaled aviptadil and reported earlier discharge (7.8 ± 4.0 versus 10 ± 5.0 days, p=0.049) with good tolerability (Esendagli et al., Med Princ Pract 2025). Whether that route is genuinely better or the trial simply enrolled a less severe population is unresolved.
- Intranasal delivery aims at absorption across nasal mucosa, with no published pharmacokinetics establishing how much reaches systemic circulation or brain tissue.
These are three different exposures, and a figure from one cannot be translated into another.
Intranasal protocols and what backs them
Detailed intranasal VIP schedules circulate in chronic inflammatory response syndrome and mould-illness communities, typically specifying microgram amounts per spray several times daily. These originate from clinical practice descriptions rather than from controlled trials, and no randomised study has evaluated intranasal VIP for those indications. The peptide's receptor biology is genuinely well characterised — VPAC1 and VPAC2 signalling in the hippocampus and immune system is mapped in detail (Cunha-Reis and Caulino-Rocha 2020) — but a mapped receptor is not a validated schedule.
The honest summary: the only VIP regimen with a published, well-powered trial behind it is an intensive-care infusion, and that trial was negative. Everything else described as a VIP protocol is unvalidated, and decisions about an investigational compound that lowers blood pressure belong within a formal clinical protocol or with a qualified clinician. Background is on the main VIP page.