Category · 10 entries
Cardiovascular & Renal
Vasopressors, vasopressin analogs, natriuretic peptides, antithrombotic peptides, and related cardiovascular/renal agents.
Angiotensin II
Giapreza — the first new vasopressor class approved in decades. FDA-approved December 2017 (La Jolla Pharmaceutical) for catecholamine-resistant septic / distributive shock based on the ATHOS-3 trial (NEJM 2017, n=321). Engages a third vasoconstrictor pathway (RAAS / AT1) independent of catecholamines and vasopressin — useful when both of those axes are desensitised.
Bivalirudin
Angiomax — the workhorse direct thrombin inhibitor for percutaneous coronary intervention. FDA-approved December 2000 (The Medicines Company, now Sandoz); the first synthetic peptide DTI to achieve broad PCI adoption. REPLACE-2, ACUITY, and HORIZONS-AMI trials established the anticoagulant profile; subsequent MATRIX trial outcomes shifted practice in some populations back toward heparin.
Carperitide
⚠ Approved in Japan only (1995). The Daiichi Sankyo recombinant hANP has been used in >30,000 pooled patients with acute heart failure in Japanese registries, but its overall mortality effect remains contested — 2024 meta-analyses suggest a possible increase in in-hospital mortality, while other pooled analyses suggest benefit at low doses.
Desmopressin
DDAVP — the classic V2-selective vasopressin analog. FDA-approved February 1978 for central diabetes insipidus; decades of label expansion added primary nocturnal enuresis, nocturia (Noctiva / Nocdurna), and hemostatic use in mild hemophilia A and type 1 von Willebrand disease. WHO Essential Medicines List.
Eptifibatide
Integrilin — the cyclic KGD-peptide GPIIb/IIIa inhibitor from pygmy rattlesnake venom. FDA-approved May 1998 (COR Therapeutics / Millennium Pharmaceuticals; now Merck / Viatris); reversible binding and short half-life make it tactically different from the monoclonal abciximab. One of two peptide-class GPIIb/IIIa antagonists in clinical use (the other being the non-peptide tirofiban).
Felypressin
⚠ Not FDA-approved. The dental-anaesthetic alternative to epinephrine — used in Europe, Japan, and Brazil as a non-catecholamine vasoconstrictor in prilocaine-based dental cartridges (Citanest® Octapressin). Useful where cardiac patients need dental work but epinephrine poses risk; unfamiliar to US dentists because of non-approval.
Nesiritide
Natrecor — the first recombinant natriuretic peptide drug for acute heart failure. FDA-approved August 2001 based on short-term dyspnea relief, became one of the most controversial drugs of the 2000s after 2005 meta-analyses raised safety concerns; ASCEND-HF (2010, n=7,141) eventually settled the safety debate but demonstrated only marginal clinical benefit. Janssen discontinued manufacturing February 2018; no longer commercially available in the US.
Terlipressin
Terlivaz — the first and only FDA-approved drug for hepatorenal syndrome (HRS). FDA-approved September 2022 (Mallinckrodt) for adults with HRS with rapid reduction in kidney function, after a multi-decade regulatory history including four prior Complete Response Letters and the successful CONFIRM Phase 3 trial (NEJM 2021).
Ularitide
⚠ Phase 3 failure. Cardiorentis's ularitide was the most recent Western attempt to develop an IV natriuretic peptide for acute heart failure. TRUE-AHF (NEJM 2017, n=2,157) failed both the mortality and hemodynamic co-primary endpoints; development was discontinued shortly after. Reinforced a now-consistent pattern of IV natriuretic peptides showing biochemical and hemodynamic effects but failing to improve clinical outcomes.
Vasopressin
Vasostrict — the endogenous antidiuretic hormone as an ICU vasopressor. FDA-approved April 2014 for adults with vasodilatory shock (post-cardiotomy, sepsis) who remain hypotensive despite fluids and catecholamines. Works through V1a receptors on vascular smooth muscle — a receptor axis pharmacologically distinct from catecholamine receptors, preserving its vasopressor effect when adrenergic receptors are desensitised.