# Carperitide, nesiritide and vosoritide: natriuretic peptide medicines and their status Updated 2026-10-16. Three laboratory-made forms of the natriuretic peptides are medicines. Carperitide, a laboratory-made copy of ANP, is approved only in Japan for acute heart failure. Nesiritide, a laboratory-made copy of BNP, was approved by the FDA in 2001 for acute heart failure and is now listed as discontinued. Vosoritide, an analogue built to act like CNP, is approved by the FDA for achondroplasia in children. | | | | --- | --- | | Carperitide | Recombinant human ANP; used in Japan for acute heart failure (Mitaka et al., 2011; Shiga et al., 2025) | | Nesiritide | Recombinant human BNP; FDA approval 10 August 2001, Natrecor, NDA 020920; listed as discontinued ([Drugs@FDA](https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=020920)) | | Vosoritide | CNP analogue, Voxzogo, NDA 214938; FDA indication in children with achondroplasia ([Drugs@FDA](https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=214938)) | | Vosoritide in Australia | Included in the ARTG, [entry 376616](https://www.tga.gov.au/resources/artg/376616) (read 16 October 2026) | | Poisons Standard, October 2026 | Nesiritide and vosoritide each have an individual Schedule 4 entry; no individual entry for carperitide, ANP or BNP was found ([F2026L01327](https://www.legislation.gov.au/F2026L01327/latest/text), read 16 October 2026) | | WADA 2026 Prohibited List | No natriuretic peptide named in the text read; in force from 1 January 2026 | Your body already makes ANP, BNP and CNP, so it is fair to ask whether doctors use them. A few are in use, each as a tightly defined hospital or specialist medicine. This guide is part of [the natriuretic peptides hub](/learn/natriuretic-peptides), and it keeps each medicine apart from the hormone it resembles. This guide records what each medicine is, what its studies measured, and what the regulators and the sport rules state on the date of reading, 16 October 2026. It does not describe how any of them is used. ## What is carperitide, and what do its studies show? Carperitide is recombinant human ANP: a copy of the body's own hormone, made in a laboratory. It is used for acute heart failure, mainly in Japan, and its clinical effectiveness has not been established. A 2025 meta-analysis pooled nine studies. Four were randomised trials and five were propensity-matched studies, which pair up similar patients to make a fairer comparison. Taken together, the carperitide groups had a higher in-hospital death rate (odds ratio 1.38; 95% CI 1.07 to 1.78). The randomised trials alone showed no significant difference (odds ratio 0.85; 95% CI 0.07 to 10.49). An odds ratio compares how often an event happened in two groups. A value of 1 means no difference. The 95% CI, or confidence interval, is the range of values that fit the data. The authors give reasons to read these numbers with care. All the included studies were run in Japan, the oldest trial is about 30 years old, and every trial was small. Two large database studies drove the pooled result, and removing them erased the difference. The authors suggest that carperitide may have been given to sicker patients in those studies. The paper also states that more recent Japanese Circulation Society guidelines do not recommend routine use of carperitide as a vasodilator, a drug that widens blood vessels, in acute heart failure. A different analysis pooled 15 randomised trials of ANP or BNP in heart surgery patients. Its measures included urine output and serum creatinine, a blood marker used to check kidney function. The authors found the combined data were not enough to judge long-term outcomes, and they called for a large trial. This page does not turn those measurements into advice. ## What is nesiritide, and where does it stand today? Nesiritide is recombinant human BNP. The FDA approved it as Natrecor on 10 August 2001, under application number NDA 020920. Today the FDA's [Drugs@FDA record](https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=020920) lists the product as discontinued. The same record notes a Federal Register determination that it was not discontinued or withdrawn for safety or effectiveness reasons. A 2011 review listed nesiritide as available in the United States, Switzerland, Argentina, Colombia and Israel. That list is a historical snapshot. It does not establish availability in those countries in 2026. The largest nesiritide trial is covered in [the ASCEND-HF guide](/learn/natriuretic-peptides/ascend-hf-nesiritide-trial). In that trial of 7,141 patients, the dyspnoea (breathlessness) result did not meet its pre-specified bar. The authors concluded that nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure. The sources opened for this page do not say why the product was discontinued, and no reason is guessed here. ## What is vosoritide, and why is a CNP analogue a medicine? Vosoritide (Voxzogo) is a CNP analogue, a laboratory-made molecule built to act like CNP. The FDA gave it accelerated approval for children with achondroplasia whose growth plates are still open. Growth plates are areas of cartilage near the ends of bones, where bones grow longer. The approval rests on annualized growth velocity, a measure of growth over a year. Continued approval may depend on confirmatory trials. The [FDA label](https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/214938s004lbl.pdf) names natriuretic peptide receptor B (NPR-B) as its receptor. It describes a pathway involving endochondral bone growth, the process by which cartilage becomes bone. That record applies only to the named medicine and patient group. The label concerns children with a genetic condition. It ties the mechanism to a gain-of-function change in the FGFR3 gene, a growth-plate signalling gene. Gain-of-function means the change makes the gene's product more active than normal. [The ANP, BNP and CNP comparison](/learn/natriuretic-peptides/anp-vs-bnp-vs-cnp) shows vosoritide's place in the family. In Australia, vosoritide is included in the Australian Register of Therapeutic Goods (ARTG), the national register of medicines and other health products, under [entry 376616](https://www.tga.gov.au/resources/artg/376616) (read 16 October 2026). An ARTG entry covers one specific product. It does not approve every preparation or every indication, meaning every condition a product is used for. ![Cutaway of a long bone end showing a sage cartilage band above terracotta bone with an upward arrow, labelled Growth plate, Cartilage and Bone.](/assets/content/edu-growth-plate-cartilage-to-bone.png) Vosoritide's FDA label describes a pathway in endochondral bone growth, where cartilage in the growth plate becomes bone; its approval covers children with achondroplasia and open growth plates. Source: FDA Voxzogo label, 2024. ## What is the Australian Poisons Standard status of these medicines? Australia's Poisons Standard sorts medicines into schedules, or control levels. In the Therapeutic Goods (Poisons Standard—October 2026) Instrument 2026, F2026L01327, nesiritide and vosoritide each have their own entry in Schedule 4, the schedule for prescription-only medicines. The [instrument text](https://www.legislation.gov.au/F2026L01327/latest/text) was read on 16 October 2026. A text search found no individual entry for carperitide, anaritide, ularitide or ANP, and no use of the phrase natriuretic peptide. A missing name alone does not establish a product's regulatory status. This page leaves the meaning of those missing entries unresolved. Schedule 4 is a control level for medicines that need a prescription, as [the Schedule 4 guide](/learn/peptides-and-australian-law/what-schedule-4-and-appendix-d-mean) explains. A schedule entry and an ARTG entry are separate records. The ARTG status of nesiritide and carperitide is not established on this page. The TGA, Australia's medicines regulator, states that a 'research use only' disclaimer alone does not change a product's regulatory status. It said so in an [advisory on 13 April 2026](https://www.tga.gov.au/safety/safety-monitoring-and-information/safety-alerts/understanding-your-responsibilities-when-importing-compounding-and-supplying-unapproved-peptide-products). An ARTG registration covers one specific product. A similar name alone does not establish that a sample is that registered product. ## Are carperitide, nesiritide or vosoritide on the WADA Prohibited List? None of the three is named in the [WADA 2026 Prohibited List](https://www.wada-ama.org/sites/default/files/2025-09/2026list_en_final_clean_september_2025.pdf) text read for this page. WADA is the World Anti-Doping Agency, and the List is in force from 1 January 2026. The List does not name ANP, BNP or any natriuretic peptide. But the List also has broad classes. Class S5 covers all diuretics and masking agents, plus substances with similar chemical structures or biological effects. Class S0 covers drugs not dealt with in later sections of the List that have no current approval from any government health regulator for human therapeutic use. Neither class is limited to named examples. Whether a natriuretic peptide medicine falls within a broader class is not established on this page. Absence of a named entry does not establish permission in sport. A wider look at the topic is in [the guide to peptides and drug tests](/learn/peptide-science/do-peptides-show-up-on-drug-tests). ## What does this page leave unresolved? Several facts are not established here. The half-lives of carperitide and nesiritide were not confirmed against a primary label. The Japanese label for carperitide was not opened. The ARTG status of nesiritide and carperitide is unknown to this page. Reviews mention other forms and analogues, but those are outside this comparison. Their primary trials were not checked, so no findings for them are reported. Nothing here shows that any of these medicines works for any person who is not in the studied group. The fair summary is narrow. Three natriuretic peptide products have regulator records, each for a named condition. Two have trial or meta-analysis evidence that is mixed or small. The third was approved on a measure of growth. [The natriuretic peptides hub](/learn/natriuretic-peptides) lists the other guides. ## Comparison Regulatory and evidence records for the three natriuretic peptide medicines, read 16 October 2026. The table records what each source states, not a ranking and not advice. | Medicine | Peptide form | Regulator record | Evidence noted | | --- | --- | --- | --- | | Carperitide | Recombinant human ANP | Approved only in Japan (Shiga et al., 2025); no Australian entry found in the Poisons Standard | Meta-analysis of nine studies; effectiveness not established (Shiga et al., 2025) | | Nesiritide | Recombinant human BNP | FDA approval 10 August 2001; listed as discontinued; Schedule 4 in the October 2026 Poisons Standard | ASCEND-HF, 7,141 patients: dyspnoea result missed its pre-specified bar (O'Connor et al., 2011) | | Vosoritide | CNP analogue | FDA accelerated approval in children with achondroplasia; ARTG entry 376616; Schedule 4 in the October 2026 Poisons Standard | Approval rests on annualized growth velocity; confirmatory trials may be required (FDA, 2024) | ## Frequently asked questions ### Is carperitide approved outside Japan? A 2025 meta-analysis states that carperitide is approved only in Japan, where its use is also restricted. No approval elsewhere was found in the sources read for this page. ### Is nesiritide an approved medicine? The FDA approved Natrecor (nesiritide) on 10 August 2001, and the FDA's [Drugs@FDA record](https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=020920) now lists it as discontinued. Nesiritide has an individual Schedule 4 entry in the October 2026 Poisons Standard. ### What is vosoritide used for? The FDA label for Voxzogo identifies vosoritide as a CNP analogue with accelerated approval for children with achondroplasia and open growth plates. The approval rests on a measure of yearly growth, and continued approval may depend on confirmatory trials. ### Is ANP a Schedule 4 substance in Australia? No individual entry for ANP or atrial natriuretic peptide was found in the text of the October 2026 Poisons Standard, F2026L01327, read 16 October 2026. This page does not say what the absence of an entry means for any supply. ## Citations - Shiga T, Suzuki A, Inoue S, Hashiguchi M.. BMC Cardiovascular Disorders. 2025;25:896. DOI: 10.1186/s12872-025-05394-0 - O'Connor CM, Starling RC, Hernandez AF, et al.. New England Journal of Medicine. 2011;365(1):32-43. DOI: 10.1056/NEJMoa1100171 - Mitaka C, Kudo T, Haraguchi G, Tomita M.. Critical Care. 2011;15(5):R258. DOI: 10.1186/cc10519 --- Canonical page: https://www.formlaboratories.com/learn/natriuretic-peptides/carperitide-nesiritide-and-vosoritide Form Laboratories - Perth-based research-use-only peptide supplier, shipping Australia-wide. - Site guide for agents: https://www.formlaboratories.com/llms.txt - Sitemap: https://www.formlaboratories.com/sitemap.xml - Full catalogue: https://www.formlaboratories.com/shop - Contact: hello@formlaboratories.com All materials are supplied for laboratory research use only - not for human or veterinary use, and nothing on this site is medical advice.