Which of the following drugs is only available as an Intravenous (IV) infusion: neraxibin (nerandomilast), elinzanetant, paltusotine, or elamipretide?

IV-Only Formulation Among Listed Medications

Elamipretide is the only drug among the four options that is exclusively available as an intravenous infusion. 1, 2

Formulation Analysis by Drug

Elamipretide (IV Infusion Only)

• Elamipretide is administered exclusively as a continuous IV infusion, as demonstrated in clinical trials where patients with heart failure received single 4-hour infusions at doses ranging from 0.005 to 0.25 mg·kg⁻¹·h⁻¹ 1
• The drug is a water-soluble, aromatic-cationic, mitochondria-targeting tetrapeptide that must be delivered intravenously to achieve therapeutic plasma concentrations 2
• Peak plasma concentrations occur at end-infusion and become undetectable by 24 hours post-infusion, confirming the necessity of IV administration for drug delivery 1
• No oral, subcutaneous, or intramuscular formulations of elamipretide exist or have been studied in clinical trials 1, 2

Elinzanetant (Oral Formulation)

• Elinzanetant is administered as once-daily oral tablets at a dose of 120 mg for treatment of menopausal vasomotor symptoms 3
• The drug was given as an oral suspension containing [¹⁴C]-elinzanetant in mass balance studies, confirming oral bioavailability 4
• Elinzanetant is rapidly absorbed following oral administration, with extensive first-pass metabolism primarily via cytochrome P450 3A4 4

Paltusotine (Route Not Specified in Evidence)

• No evidence provided regarding paltusotine formulation or route of administration
• Cannot definitively characterize based on available evidence

Nerandomilast/Neraxibin (Route Not Specified in Evidence)

• No evidence provided regarding nerandomilast formulation or route of administration
• Cannot definitively characterize based on available evidence

Clinical Implications of IV-Only Administration

The IV-only formulation of elamipretide requires specific clinical considerations:

• Patients require established IV access for drug administration, which may limit outpatient use 1
• Continuous infusion protocols necessitate inpatient monitoring or infusion center administration 1
• The short half-life and rapid clearance (undetectable by 24 hours) means repeated infusions are required for sustained therapeutic effect 1
• Blood pressure and heart rate monitoring is required during infusion, though the drug has demonstrated stable hemodynamic profiles in heart failure patients 1