Synthetic version of vasoactive intestinal peptide, a natural vasodilator. Combined with phentolamine, it is used as a penile injection for erectile dysfunction in some European countries; as a treatment for severe COVID-19 it failed.
FDA (US): Not approved (the FDA twice declined emergency use authorization for critical COVID-19, in 2021 and 2022)
EMA (EU): No centralized EMA authorization; authorized nationally in some European countries (e.g., United Kingdom, 2015, Invicorp: aviptadil 25 µg + phentolamine 2 mg) for erectile dysfunction
Dose
Erectile dysfunction: one ampoule of aviptadil 25 µg + phentolamine 2 mg by intracavernosal injection, no more than once a day or three times a week; the first injections are given by health care staff (Invicorp prescribing information, UK 2015).
Safety
About 10% have adverse effects, mainly facial flushing and bruising at the injection site. Rarely, prolonged erection (priapism) or penile fibrosis. Requires a prescription and medical training.
Interactions
The phentolamine in the combination may add its blood-pressure-lowering effect to that of other drugs that lower blood pressure.
Differences between women and men
Its approved indication (erectile dysfunction) is for adult men only.
Effect by goal · level of evidence
Erection sufficient for intercourse in erectile dysfunction
improvesModerateRCT (AA)in people
75% vs 12% response
Double-blind trial with 304 men: 84% responded in the dose-titration phase and 66–75% responded vs 10–12% with placebo. Facial flushing in 34% of injections; priapism in 0.05%.
VIP relaxes the smooth muscle of blood vessels and erectile tissue. Together with phentolamine, which blocks receptors that constrict vessels, it increases blood flow to the penis and facilitates erection. It also has anti-inflammatory effects in the lung, which prompted its study in COVID-19.
What the evidence says
In people
Erection sufficient for intercourse in erectile dysfunction. Double-blind trial with 304 men: 84% responded in the dose-adjustment phase and 66–75% responded vs 10–12% with placebo. Facial flushing in 34% of injections; priapism in 0.05%. PubMed 10356669
Respiratory failure from COVID-19. TESICO trial with 461 hospitalized patients: no benefit in recovery at 90 days and similar mortality (38% vs 36% with placebo); it was stopped for futility. PubMed 37348524