What is the recommended protocol for Avipetadil (Ryaltris) infusion in patients with pulmonary arterial hypertension?

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Last updated: November 7, 2025View editorial policy

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Aviptadil Infusion Protocol

Critical Clarification

There is no established infusion protocol for Aviptadil (also known as vasoactive intestinal peptide or VIP) in pulmonary arterial hypertension, as this drug is not approved or recommended for PAH treatment. You may be confusing Aviptadil with approved PAH therapies, or referring to Ryaltris (which is actually an intranasal spray for allergic rhinitis, not a PAH medication).

Evidence Review

Aviptadil in Pulmonary Hypertension

  • Aviptadil has only been studied as an inhaled agent in a single small acute study, where 20 patients with various forms of PH inhaled a single 100-microgram dose during right heart catheterization 1

  • The acute effects were modest and short-lived: only 6 of 20 patients (30%) experienced a pulmonary vascular resistance reduction of >20%, with temporary selective pulmonary vasodilation that did not persist 1

  • No chronic infusion protocols exist for Aviptadil in PAH, as it has never progressed beyond this single-dose inhalation study for pulmonary hypertension 1

  • Aviptadil received Orphan Drug Designation for ARDS and PAH in 2001 and 2005 respectively, but this does not mean it is approved or that treatment protocols have been established 2

Current PAH Treatment Standards

For patients with pulmonary arterial hypertension requiring parenteral therapy, the established options are:

  • Intravenous prostacyclin analogues (epoprostenol, treprostinil) are recommended for high-risk PAH patients, not Aviptadil 3

  • Risk stratification guides therapy selection: high-risk patients (WHO FC IV, 6MWD <165m, cardiac index <2.0 L/min/m², RAP >14 mmHg) should receive intravenous prostacyclin therapy 4

  • Right heart catheterization is mandatory to confirm diagnosis, assess severity, and guide therapeutic decisions before initiating any advanced PAH therapy 4, 3

Clinical Recommendation

If you are seeking an infusion protocol for severe PAH, you should be using intravenous epoprostenol or treprostinil, not Aviptadil. These are the only parenteral therapies with established protocols, proven efficacy in reducing mortality, and guideline recommendations for high-risk PAH patients 3, 5.

Aviptadil should not be used for PAH treatment outside of clinical trials, as there is insufficient evidence of efficacy and no established dosing regimens for this indication 1.

References

Research

Anticipated pharmacological role of Aviptadil on COVID-19.

Environmental science and pollution research international, 2022

Guideline

Treatment of Pulmonary Hypertension

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Treatment algorithm for pulmonary arterial hypertension.

The European respiratory journal, 2024

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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